Comparative study of surgically induced astigmatism following small incision cataract surgery with incision placed in superior and temporal meridian (original) (raw)
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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.
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.
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...
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).
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.
Site of Incision and Corneal Astigmatism in Conventional SICS versus Phacoemulsification
Annals of Ophthalmology, 2007
Introduction High astigmatism is an important cause of poor uncorrected visual acuity after cataract surgery. Purpose The aim of the study is to compare the astigmatism induced by a superior and temporal incision in manual SICS, and to compare the astigmatism induced by clear corneal incision versus scleral tunnel in phacoemulsification surgery. Methods A total of 64 eyes of 64 patients (34 male/30 female) with a mean age of 62.10 years (range 45–82 years) were included in the study. The cases were randomly divided into two groups. One group (Group I) had undergone manual SICS and the other group (Group II) had undergone phacoemulsification. The manual SICS group patients were randomly allotted into two subgroups depending on the site of incision. Group Ia received superior incision while group Ib received temporal incision. The Phacoemulsification group (Group II) patients were randomly divided into two groups depending on the location of the incision. Group IIa received clear corneal incision and group IIb received scleral pocket incision. Informed consent was obtained from all the patients undergoing study. Surgically induced astigmatism is calculated by the substraction method. Results and Conclusion We found significantly against the rule shift in stigmatism in the phacoemulsification group and the manual SICS superior incision group. The manual SICS group with temporal incision (Ib) had with-the-rule shift in astigmatism. Synopsis At 90 days, conventional SICS superior incisions gave 1.92 ± 0.53 D against the rule and temporal incisions 1.57 ± 0.24 D with the rule astigmatism. Phacoemulsification clear corneal incisions showed 1.08 ± 0.36 D and scleral pocket 1.23 ± 0.71 D astigmatism.
Journal of Medical Science And clinical Research, 2019
To decrease astigmatism in cataract as well as trabeculectomy different modification have been tried in the incision shape, size and sites. Sutureless trabeculectomy and 'W' shaped incision trabeculectomy is also few of them. A randomized, prospective, interventional and comparative clinical trial carried out on 39 eyes of 39 patients with primary open angle glaucoma (POAG) with coexisting cataract. The aim of the study was to compare the astigmatism of combined manual Small-Incision Cataract Surgery (SICS) and posterior chamber intraocular lens (PCIOL) implantation with Trabeculectomy by sutureless [group A] versus combined SICS and PCIOL implantation with trabeculectomy using 'W' shaped incision technique [group B]. Surgically induced ATR Astigmatism in group A was 1.57±0.37D while in group B was 1.28±0.39D [p=0.028]. None of the patient in either group had surgically induced WTR astigmatism. Due to the high mechanical stability of the W-shaped incision and suture, comparatively less induced astigmatism was seen in combined surgery done with W-shaped incision in comparison to combined SICS with sutureless trabeculectomy. Both the procedures are safe as none of the patient in any group had any major complication or sight loss due to surgery
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.
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.