Astigmatic Changes in Sutureless Small Incision Cataract Surgery (original) (raw)
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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...
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.
Clinical Optometry, 2016
To investigate which of two tunnel incision forms (frown versus straight) in sutureless manual small incision cataract surgery creates more corneal astigmatism. Sixty eyes of 60 patients who had consented to undergo cataract surgery and to partake in this study were followed from baseline through 12-week postoperative period. Values of pre operative and post operative corneal astigmatism for the 60 eyes, measured with a Bausch and Lomb keratometer, were extracted from the patients' cataract surgery records. Residual astigmatism was computed as the difference between preoperative and postoperative keratometry readings. Visual acuity was assessed during the preoperative period and at each postoperative visit with a Snellen chart at 6 m. Fifty eyes of 50 patients were successfully followed-up on. Overall, the mean residual astigmatism was 0.75±0.12 diopters. The differences in mean residual astigmatism between the two different incision groups were statistically significant (t [48]=6.33, P,0.05); frown incision group recorded 1.00±0.12 diopters, whereas the straight incision group recorded 0.50±0.12 diopters. No significant difference was observed between male and female groups (t [48]=0.24, P0.05). Residual corneal astigmatism in the frown incision group was significantly higher than in the straight incision group. Fisher's exact test did not reveal a significant association between incision forms and visual acuity during the entire postoperative period (P0.05).
Abstract: To investigate which of two tunnel incision forms (frown versus straight) in sutureless manual small incision cataract surgery creates more corneal astigmatism. Sixty eyes of 60 patients who had consented to undergo cataract surgery and to partake in this study were followed from baseline through 12-week postoperative period. Values of preoperative and postoperative corneal astigmatism for the 60 eyes, measured with a Bausch and Lomb keratometer, were extracted from the patients’ cataract surgery records. Residual astigmatism was computed as the difference between preoperative and postoperative keratometry readings. Visual acuity was assessed during the preoperative period and at each postoperative visit with a Snellen chart at 6 m. Fifty eyes of 50 patients were successfully followed-up on. Overall, the mean residual astigmatism was 0.75±0.12 diopters. The differences in mean residual astigmatism between the two different incision groups were statistically significant (t [48]=6.33, P,0.05); frown incision group recorded 1.00±0.12 diopters, whereas the straight incision group recorded 0.50±0.12 diopters. No significant difference was observed between male and female groups (t [48]=0.24, P.0.05). Residual corneal astigmatism in the frown incision group was significantly higher than in the straight incision group. Fisher’s exact test did not reveal a significant association between incision forms and visual acuity during the entire postoperative period (P.0.05).
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.
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...
Innovative Publication, 2017
Aim: To evaluate the effect of 6mm sutureless clear corneal incision on pre-existing astigmatism of 1D-2D and to compare outcome of superior and temporal incisions, in manual small incision cataract surgery (SICS). Methods: A prospective interventional study was conducted from January 2015 to July 2015 on 80 patients who underwent manual SICS, with pre-existing astigmatism of 1D-2D on keratometry. A 6mm superior or temporal sutureless clear corneal incision was made along the steep axis. Postoperative follow up was done on 1 st , 3 rd and 6 th week and keratometry values noted in each visit. Final refraction and correction noted at the end of 6 weeks Results: Out of 80 patients, 71 had 1D-1.5 D and 9 had 1.5D-2D astigmatism. The mean pre-operative astigmatism was 1.228D±0.32D. Among 62 cases of with-the rule astigmatism, full correction after surgery was noted in 37 patients (59.67%), partial correction in 19 (30.64%), no change in 6(10%). Among 18 cases of against-the rule astigmatism, 11 had full correction (61.11%) and 6 had partial correction (33.33%) and remained unchanged in 1(5.5%). So the mean post-operative astigmatism was found to be 0.43D±0.35. The astigmatic difference between pre-operative and post-operative astigmatism was found to be statistically significant. (P-value 0.0001). Peaking of pupil was noted in 3 patients and iris prolapse in two patients, accounting for minor complications in 6.7%. No other complications were observed till 6 weeks. Conclusion: A 6mm sutureless clear corneal incision on steep axis is an economical and effective way of reducing pre-existing astigmatism of 1D-2D in manual SICS.
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.
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
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.