Comparison of post operative astigmatism from superiotemporal vs temporal incision in small incision cataract surgery (original) (raw)
Related papers
Medicine Today, 2014
This prospective study was designed to evaluate and compare surgically induced astigmatism in small incision cataract surgery through superior, supero-temporal and temporal approach. Astigmatism means no point focus. It is a refractive error that occurs when the optical system does not have the same refractive power at all its meridian. The location and width of incision will determine the amount of surgically induced astigmatism (SIA) in small incision cataract surgery. Temporal and superotemporal incisions are less likely to induce post operative astigmatism than the 12 o' clock incisions. The study was carried out at Tairunnessa Memorial Medical College and Hospital, Gazipur, Faridpur Diabetic Association Medical College and Hospital, Faridpur and General Hospital, Faridpur, Bangladesh, from January 2012 to June 2013.Total number of 120 eyes of 108 patients, both male and female patients were included for the study. We excluded the patients having corneal scar, irregular asti...
Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Cataract surgery is a boon in itself. With all the possible modalities of cataract surgery, we try to give a normal vision. But Surgically Induced Astigmatism (SIA) is one of the causes of a poor quality of vision. We have studied SIA in 2 different sites of incision in Manual Small Incision Cataract Surgery (SICS). The objective of this study is to compare the amount of surgically induced astigmatism in superior and temporal incisions in manual small incision cataract surgery. MATERIALS AND METHODS Hundred patients were studied. The patients were randomly assigned to any of the two groups. The two groups had 50 patients each. The patients in Group A underwent manual SICS with a superior incision. The patients in Group B underwent manual SICS with a temporal incision. The patients were examined on the post-operative weeks 1, 3 and 6. The uncorrected and the bestcorrected visual acuity was recorded and a slit-lamp examination and auto-refractometer and keratometry examinations were also done. RESULTS In our study at 6 weeks post-operatively we found almost 80% people with astigmatism < 0.5D in temporal section, while there were 20% people in superior section. We also found that in temporal sclera group, there was reduction of pre-operative ATR astigmatism from 66% to 64% and there was no change in pre-operative WTR astigmatism which was 30% pre-and postoperative (6 weeks). CONCLUSION SICS which is done with a temporal approach provides a better quality of vision due to a significantly less SIA than the superior approach.
ABSTRACT: BACKGROUND: Manual small incision cataract surgery is a simple and less expensive technique of cataract surgery but gives visual result almost equivalent to Phacoemulsification. PURPOSE: To compare surgery induced astigmatism in manual small incision cataract surgery through superior and temporal approaches. METHODOLOGY: One hundred and thirty eyes were included in this study. Eyes with steeper vertical keratometric reading were subjected to superior small incision cataract surgery (SICS) and those with a steeper horizontal keratometric reading were subjected to temporal small incision cataract surgery (SICS). Eyes with no astigmatism were randomly subjected to either type of surgery. Each group had 65 eyes. All the patients were followed up on 1st, 7th, 30th and 90th postoperative days. During each follow up, UCVA and BCVA were recorded, slit lamp examination was performed; autorefractometry and keratometric examinations were also performed. RESULTS: Out of 65 in the temporal incision group only 55 completed follow up till 90th day. The mean surgery induced astigmatism was found to be 1.45 ± 0.4 D in superior and 0.70 ± 0.3 D in the temporal incision group. Amount of surgery induced astigmatism was found to be significantly lower among the temporal incision group (t = 11.444, p = 0.000). CONCLUSION: SICS through temporal approach provides a better stabilization of refraction with significantly lesser amount of SIA than superior approach.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Cataract extraction is the largest surgical workload in the world. Goal of the modern cataract surgery is to reduce pre-operative astigmatism after operation to improve visual acuity and quality. Regarding the choice of incision location, previous studies reports that the superior incision induces greater change in corneal astigmatism (against the rule) than temporal (with the rule). With The Rule (WTR) is preferred, because it allows better uncorrected visual acuity. With The Rule (WTR) is preferred in most cases, as it frequently allows better uncorrected visual acuity. Nowadays, phacoemulsification remains the more advanced and technically superior method of cataract surgery; it is not always either from a cost purpose and its limitations of few type of cataracts. When incision is located superiorly, both gravity and eyelid blink tend to create a drag on the incision. These forces are better neutralised with temporal incision, because it is parallel to the vector of the forces. With-the-rule astigmatism induced by a temporal incision is advantageous, because most elderly patients have preoperative against-the-rule astigmatism. When incision is located superiorly, both gravity and eyelid blink tend to create a drag on the incision. These forces are better neutralised with temporal incision, because it is parallel to the vector of the forces. With-the-rule astigmatism induced by a temporal incision is advantageous, because most elderly patients have preoperative against-the-rule astigmatism. MATERIALS AND METHODS Subjects of the study were selected from consecutive cases of patients attending the Outpatients Departments of Ophthalmology with consideration of inclusion and exclusion criteria properly, NRS Medical College and Hospital, Kolkata from Nov. 2011 to Sept. 2012. RESULTS The surgically induced astigmatism in temporal SICS (0.98 ± 0.59) is much lower than superior SICS (1.45 ± 1.24) and the difference is statistically very significant (as P value is < 0.01). In age wise distribution table, Surgically Induced Astigmatism (SIA) in temporal SICS is lower than superior SICS. It is clinically significant and statistically significant (P value < 0.05) in all age groups except in < 40 yrs. In superior SICS male vs female, difference in SIA is statistically insignificant (p value > 0.05) and in temporal SICS difference is also statistically insignificant, (p value > 0.05), hence the value is independent on gender factor. CONCLUSION The age wise distribution and comparison table between patients undergoing superior and temporal SICS found that the temporal approach SICS gives less surgically induced astigmatism in all age groups and it is statistically significant (p value) in all groups (except in the age group < 40 yrs.). But as the sample is very small compared to other age groups, so anything cannot be concluded. So overall the study found that the surgically induced astigmatism in temporal SICS is lower than superior SICS and it is statistically significant.
International Journal of Advance Research, Ideas and Innovations in Technology, 2017
Small incision Cataract Surgery (SICS)-the first choice alternative to phacoemulsification as it retains most of the advantages of "phaco" giving visual results equivalent to phacoemulsification at a lower cost. However, the larger incision used induces greater astigmatism than phacoemulsification. (8) With improved techniques and increased expectations, surgeons have been paying closer attention to the astigmatic effects of their surgeries. (9) Minimal postoperative astigmatism, rapid visual rehabilitation and the best corrected visual acuity possible are the aims of modern cataract surgery. The axiom today in the rehabilitation of a patient of cataract is "Small is beautiful". (10) Small incision cataract surgery (SICS) through a sclerocorneal tunnel has come as a boon as it has been demonstrated that smaller the incision valvular construction of wound would induce minimal astigmatism.(11) AIMS AND OBJECTIVES 1. To compare between the surgically induced astigmatism (SIA) in small incision cataract surgery (SICS) by superior incision, temporal incision, and supero-temporal incision. 2. To evaluate the change in preoperative and postoperative astigmatism. 3. To study the effect of three different incision sites on postoperative best corrected visual acuity.
Indian Journal of Clinical and Experimental Ophthalmology
Background: Cataract surgery now a days has become a refractive surgery. It not only improves the vision, but also provides good unaided visual acuity(VA). Sutureless small incision cataract surgery(SICS) induces minimum astigmatism. It also helps in early rehabilitation by faster stabilisation of post-operative refraction. Objective: The aim of this prospective observational study was to compare the Surgery induced astigmatism(SIA) and VA following manual SICS with superior and temporal incisions. Materials and Methods: Consecutive 100 patients in the age group of 40-70 years with cataract having VA<6/18, having no ocular comorbidities were included in the study. After proper evaluation, 50 patients underwent manual SICS with superior scleral incision and rest 50 with temporal incision. Post operative astigmatism was measured at 4 th and 8th weeks. Best corrected VA was checked at 8 th week. SIA was calculated at 4 th and 8 th week post operatively. The statistical analysis was done with the help of SPSS 18 statistical analysis software, measuring p value, mean and standard deviation. Results: The mean SIA in superior and temporal SICS at 4 rth week was 1.06+/-0.41 DCyl and 0.75+/-0.36 DCyl respectively (p=0.000) and at 8 th week was 0.99+/-0.31 DCyl and 0.64+/-0.32 DCyl respectively (p=0.000). The difference of SIA at 4 rth and 8 th week in both the techniques was statistically insignificant.41 patients with superior incision and 43 patients with temporal incision had VA of 6/6 at 8 th post operative week.VA was 6/9 in 6 patients with superior incision and 3 patients with temporal incision. Whereas, VA was 6/12 in 3 patients with superior incision and 4 patients with temporal incision at 8 th post operative week.VA at 8 th post-operative week in both the techniques were comparable. Conclusion: SIA in temporal SICS is significantly lesser than that in superior SICS whereas VA in both the techniques is excellent and comparable.
International Journal of Clinical and Experimental Ophthalmology
Background: In developing countries, manual small incision cataract surgery is a better alternative and less expensive in comparison to phacoemulsification and thus the incision is an important factor causing high rates of postoperative astigmatism resulting into poor visual outcome. Thus, modifications to the site of the incision is needed to reduce the pre-existing astigmatism and also to prevent postoperative astigmatism. Modification to superotemporal incision relieves pre-existing astigmatism majorly due to its characteristic of neutralizing against-the-rule astigmatism, which is more prevalent among elderly population and thus improves the visual outcome. Aims: To study the incidence, amount and type of surgically induced astigmatism in superior and superotemporal scleral incision in manual SICS. Methodology: It is a randomized, comparative clinical study done on 100 patients attending the OPD of Ophthalmology at a tertiary care hospital, with senile cataract within a period o...
IOSR Journals , 2019
Introduction: Cataract surgery has become one of the most common and successful procedures in ophthalmology. In addition to improving visual acuity (VA), one of the goals of modern cataract surgery is to reduce pre-existing astigmatism (PEA), a factor that may reduce VA and affect the quality of vision. Materials and Methods: 100 patients of cataract attending to District Hospital Baramulla with the rule and against the rule astigmatism were included in the study. The astigmatic profile and the effect of surgical incision on astigmatism were studied. A prospective study was done in which patients were divided into two groups. MSICS was performed with superiorly located incision in group I and temporally located incision in group II. Results: Out of the total 100 patients undergoing MSICS, 59 patients had ATR, 36 patients had WTR and 5 patients had no astigmatism. Thus the pre-operative astigmatic profile shows that ATR is more common type of astigmatism in this group. Among 50 patients in superior incision group, 18 had pre-operative WTR, 29 had ATR and 3 did not have astigmatism. Postoperatively the no. of patients with WTR decreased to 10, the no. of patients with ATR increased to 35 showing that superior incision flattens vertical meridian and steepens the horizontal meridian causing ATR shift. Among 50 patients in temporal incision group, 18 had pre-operative WTR, 30 had ATR and 2 did not have astigmatism. Post operatively the no of patients with WTR increased to 25, the no of patients with ATR decreased to 20. Conclusion: Placement of incision on steep axis reduces pre-existing astigmatism. Thus in ATR astigmatism it is placed temporally and in WTR astigmatism it is placed superiorly. Thus a simple modification in incision placement can minimize surgically induced astigmatism and reduce pre-existing astigmatism
IP Innovative Publication Pvt. Ltd, 2017
Cataract is one of the most important curable causes of blindness in India. Nowadays although the 'cataract surgery of choice' is phacoemulsification; manual small incision cataract surgery (SICS) has emerged as an alternative technique owing to its being cost-effective and having all advantages of a self-sealing sutureless incision but with the disadvantage of having higher postoperative astigmatism. The aim of our study was to compare the surgical outcome using two different incision sites – " superior and temporal " in terms of surgically induced astigmatism. After taking Informed consent all the patients were divided randomly into two groups. Group S received Superior incision and group T Temporal incision. All surgeries were performed under peribulbar anesthesia using an incision size of 6 – 6.5 mm. The incision architecture was kept same in both the groups. Postopratively patients were examined on days 1, 7, 30, 45 and 90. Keratometry with Uncorrected and Best corrected visual acuity was recorded on subsequent visits. The surgically induced astigmatism (SIA) was calculated by Vector method. When SIA was compared between the two groups, both in magnitude as well as axis, the change was found to be lower in temporal group as compared to superior group S. It was statistically significant (p=0.004). We therefore conclude that though both the groups had good postoperative visual acuity patients of group S had more postoperative and surgically induced astigmatism and therefore greater dependence on spectacles as compared to group T and this was found to be statistically significant.
Assessment of astigmatism in manual and sutureless small incision cataract surgery
New Frontiers in Ophthalmology, 2016
Introduction: Cataract surgery is experiencing progress and adaptations in recent years with the aim to obtain better anatomical and functional results. Extraction of cataract by phacoemulsification has become a gold standard with its multiple variants. In developing countries, the cataract surgery by manual and sutureless small incision technique (MSICS) is increasingly practiced. The aim of this study is to assess astigmatism before and after cataract surgery by MSICS. Patients and methods: This is a descriptive, prospective and single-center study on cataract patients operated by temporal superior MSICS with insertion of a standard posterior chamber lens. Astigmatism was assessed preoperatively and postoperatively regularly for 3 months with an auto-refractometer. Results: A total of 100 eyes of 100 patients met our inclusion criteria. The mean age was 62.34 ± 11.21 years. Visual acuity was reduced to blindness in 64% of cases and low vision in 36% before surgery. The mean preoperative astigmatism was 1.27 ± 0.64 D. On day 90 postoperative (D90), visual acuity was greater than or equal to 3/10 in 73% uncorrected and 91% with pinhole. The mean postoperative astigmatism was 0.90 ± 0.60 diopter at D90. Discussion: The cataract surgery by MSICS offered in this small sample, a good vision in 91% with a reduction of the power of the preoperative astigmatism without a modification of the axis. Conclusion: Cataract surgery by temporal superior MSICS seems to offer good functional results with a reduction of astigmatism. MSICS technique would prepare eye surgeons for phacoemulsification. The insertion of an IOL after an ocular biometry will improve these preliminary results in patients operated by MSICS in developing countries where the demand of toric lenses is important.