A comparative study of post-operative astigmatism in superior versus superotemporal scleral incisions in manual small incision cataract surgery in a tertiary care hospital (original) (raw)
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National Journal of Medical Research, 2012
Aim: To evaluate the amount and type of surgically induced astigmatism in superior and temporal scleral incision in Manual Small Incision Cataract Surgery (MSICS). Material and Methods: A prospective randomized comparative study was carried out in 100 cases of senile or pre-senile cataract. All the patients underwent MSICS under peribulbar anaesthesia. The patients with very hard cataract were excluded so as to keep the incision size uniformity (6-6.5mm). 50 cases received superior scleral incision and 50 cases received temporal scleral incision. Post operative astigmatism was studied in both groups using Bausch & Lomb Keratometer on 1st day, 7th day, 6th week and 3rd month. Results: After 3 months of surgery, out of 50 patients in superior scleral incision group 74% patients had ATR astigmatism and 16% patients had WTR astigmatism whereas in temporal scleral incision group 56 % of the patients had WTR astigmatism and 36 % had ATR astigmatism. The mean surgically induced astigmatism (SIA) in temporal incision group was significantly less than the superior incision group after 3 months postoperatively (t=2.33, p<0.05). Conclusion: This study reveals that temporal approach MSICS produces less postoperative astigmatism and has manifold advantages over superior incision MSICS with excellent visual outcome.
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...
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.
IP Innovative Publication Pvt. Ltd., 2017
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: It was a prospective, interventional study conducted at a tertiary care center. The study population consisted of 142 cataract patients admitted in hospital and underwent manual small incision cataract surgery. Patients were randomized and divided into two groups(group A –superiotemporal, Group B –temporal) Patients were examined on post-operative Day 1, 1week, 40days Uncorrected and best corrected visual acuity was recorded. Slit-lamp examination, auto refractometer and keratometry examination were done. Results: The mean SIA in Group1 was found to be 0.532±0.317 and in Group 2 it was 0.435±0.338. The p value accordingly was less than 0.05, which is statistically non significant. T-test was applied to compare the two groups. Conclusion: SICS with the temporal approach provides a better stabilization of the refraction with a significantly less SIA than 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.
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
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.
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.
Aims: To compare surgically induced astigmatism after manual small incision cataract surgery (MSICS) with different distance of superior corneo-scleral incision (CSI) posterior to the limbus. Material & Method: A prospective case study of 75 pateints who had undergone MSICS were divided in three groups according to the distance of superior corneo-scleral incision, 1mm, 2mm and 3 mm away from limbus in group A ,B and C respectively. The visual acuity, refraction and surgically induced astigmatism (SIA) were evaluated. Results: Mean astigmatism induced in Group A was 1.11D ,Group B was 1.04 D and in group C it was 0.62D with the difference being statistically significant. Group B and C showed significant improvement in post operative visual acuity (P<0.05) with minimum surgically induced astigmatism.The MSICS with CSI distance 2 and 3 mm is an effective measure to reduce SIA and better visual outcome. Conclusion: In MSICS surgically induced astigmatism is less with superior corneo-sclera incision more than 2mm away from limbus.
Journal of Clinical and Diagnostic Research, 2023
Introduction: Various types of incisions have been adopted and applied in Manual Small Incision Cataract Surgery (MSICS) with the primary objective to attain minimum postoperative Surgically Induced Astigmatism (SIA). Aim: To evaluate and compare the postoperative visual acuity and to determine SIA in Batwing incision and Frown incision in MSICS. Materials and Methods: The present study was a prospective, cross-sectional, interventional, comparative descriptive study in which a total of 380 patients aged 40 years and above with senile, uncomplicated cataract, undergoing MSICS were included. Patients were randomly divided into: Group B (Batwing incision), and Group F (Frown incision). Patients were compared on 6 th week postoperatively for Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA) and SIA (performed using SIA Calculator Version 2.1). The data was collected in terms of demographic, clinical and biochemical characteristics that were expressed as range, mean and median and subjected to statistical analysis to obtain results. Results: In group F, total 04 (2.11%) patients showed no astigmatism, 115 (60.53%) patients showed 0-0.5D of SIA, 64 (33.68%) were seen with 0.5-1D of SIA and 07 (3.68%) patients with 1-1.5 D SIA, no patient showed SIA more than 1.5 D. In Group B 01 (0.52%) patient showed no SIA, in 61 (32.11%) 0-0.5D of SIA was seen, in 79 (41.58%) patients 0.5-1D of SIA was seen and 45 (23.68%) patients had presented with 1-1.5D of SIA while 04 (2.11%) patients with more than 1.5D of SIA. In group F, average preoperative astigmatism preoperatively was 0.55±0.36D and average astigmatism at six weeks postoperatively was 0.46±0.33D. In Group B, average preoperative astigmatism was 0.49±0.39D and average astigmatism six weeks postoperatively was 0.54±0.40D. Conclusion: The present study showed the superiority of Frown incision over Batwing incision in terms of less SIA and improved postoperative unaided visual results. www.jcdr.net Dnyanoba Mukund Darade et al., Comparative Study of Surgically Induced Astigmatism in MSICS