Corneal topographic changes and surgically induced astigmatism following combined phacoemulsification and 25-gauge vitrectomy (original) (raw)
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IOSR Journals , 2019
Introduction: Cataract surgery has undergone various advances since it was evolved from ancient couching to the modern phacoemulsification cataract surgery. Surgically induced astigmatism (SIA) remains one of the most common complications. The introduction of sutureless clear corneal incision has gained increasing popularity worldwide because it offers several advantages over the traditional sutured limbal incision and scleral tunnel. A clear corneal incision has the benefit of being bloodless and having an easy approach, but SIA is still a concern. Materials and Methods: It was a hospital-based prospective interventional comparative randomized control trial of 261 patients conducted in a rural-based secondary eye care center from September 2017 to August 2018. The visual acuity and detailed anterior segment and posterior segment examinations were done and the cataract was graded according to Lens Opacification Classification System II. Patients were divided for phacoemulsification into two groups, group A and group B, who underwent temporal and superior clear corneal approach, respectively. The patients were followed up on day 1, 7, 14, 30, and 90 postoperatively. The parameters recorded were uncorrected visual acuity, best-corrected visual acuity, slit lamp examination, and keratometry. The mean difference of SIA between 30th and 90th day was statistically evaluated using paired ttest, and all the analyses were performed using SPSS 18.0 (SPSS Inc.) software. Results: The mean postoperative SIA in group A was 0.998 D on the 30th day, which reduced to 0.768 D after 90 days, and in group B the SIA after 30 days was 1.651 D, whereas it reduced to 1.293 D after 90 days. Conclusion: Temporal clear corneal incision is evidently better than superior clear corneal incision as far as SIA is concerned.
Cureus
Background In cataract surgery, the effect of corneal incision astigmatism has been widely recognized for many years. The incision's size, shape, and location can all impact the patient's postoperative visual outcomes. Currently, phacoemulsification is considered the most preferred surgical technique for cataract extraction. However, there is still some debate about whether temporal incisions, which are smaller and considered nearly astigmatic neutral, result in more astigmatism than other incisions. As a result, it is important to continue studying the refractive changes induced by corneal incisions made at different sites during phacoemulsification surgery. Aim and objective To compare the incidence, extent, and course of postoperative astigmatic changes associated with superior versus temporal clear corneal incisions for sutureless phacoemulsification cataract surgery. Materials and method In this prospective study, 50 patients of the civil hospital in Gujrat with cataracts who underwent sutureless, small incision (2.8 mm) phacoemulsification surgery were included. The preoperative evaluation comprised visual acuity assessment, refraction, keratometry, fundus examination, and intraocular lens (IOL) power calculation. The superior incision was made in 25 patients, and the temporal incision was made in another 25 patients. Patients were examined preoperatively on day 1, at one week (day 7), after one month (day 30), and after two months (day 60). Result Postoperatively, two months (on day 60) postoperatively, in group A (superior approach), the mean surgically induced astigmatism (SIA) was 0.39±0.34 SD diopters, and in group B (temporal approach), it was 0.5±0.42 SD diopters. A significant statistical difference was not seen between these two groups. Conclusion Surgically induced astigmatism was minimal and comparable with both superior and temporal approaches to clear corneal incisions for phacoemulsification surgery.
Journal of Cataract & Refractive Surgery, 1998
Purpose: To evaluate the effect of superior and temporal clear corneal incisions on astigmatism after suturefess,small incision phacoemulsification. Setting: World Eye Hospital, Istanbul, Turkey. , Methods: This prospective study evaluated 40 eyes of 20 patients with cataract having bilateral, sutureless, small incision phacoemufsification by the . same surgeon. A superior clear corneal incision was used in all right eyes and a temporal clear corneal incision in all left eyes. Mean preoperative astigmatism was 0.63 diopter (D) ::t 0.21 (SD) and 0.65 ::t 0.20 0, respectively. Mean patient age was 66.45 years. Patients were examined preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively.
Ophthalmology research: an international journal, 2022
Background-The primary goal of cataract extraction surgery is immediate visual recovery and the best uncorrected visual acuity (UCVA) post operatively. Aim: To compare the surgically induced astigmatism (SIA) after phacoemulsification surgery with superior clear corneal incision (SCCI) and temporal clear corneal incision (TCCI). Materials & method: 11 articles were reviewed on PubMed related to SIA & a review was made on the factors that are responsible to reduce the post-operative astigmatism. The outcome measures were SIA and UCVA at 2 and 6 weeks, post-operatively. Results-In this study we expect to have better visual outcome and reduce incidence of SIA in TCCI than SCCI. Conclusion: TCCI appears to have better visual outcome and reduced incidence of SIA.
Eye, 2008
Purpose To study the surgically induced astigmatism (SIA) in combined phacoemulsification and vitrectomy, and compare with that when either procedure is performed alone. Methods This is a prospective comparative interventional trial comprising of 60 eyes of 60 consecutive patients with cataract and/or vitreo-retinal pathology. They were divided equally into three groups based on the type of procedure: Group A, phacoemulsification alone group, using a 3.0-3.2 mm wide unsutured sclero-corneal tunnel incision at 1.0 mm post-limbus at 10 o'clock; Group B, par plana vitrectomy alone group, using three sclerotomies at 3.5 mm post-limbus at 2, 8, and 10 o'clock (right eye) or at 2, 4, and 10 o'clock (left eye) positions; and Group C, combined phacoemulsification and pars plana vitrectomy group. Main outcome measures were the amplitude (K-induced) and the axis of SIA calculated by rectangular coordinate method using the Holladay-Cravy-Koch formula. Results The mean K-induced amplitudes were 0.19±0.14 D, 0.17±0.11 D, and 0.23 ± 0.19 D for groups A, B, and C, respectively. The range of K-induced amplitudes for the entire cohort was 0.00-0.77 D. No overall statistically significant differences in the pre-and postoperative topographic astigmatism amplitudes and the K-induced between groups A, B, and C were found (all P40.05). Minor shifts, of doubtful clinical significance, in the axes of SIA were present. Conclusions Combined phacoemulsification and pars plana vitrectomy does not induce significant astigmatic change per se, and its amount is similar to that when either procedure is performed alone.
Ophthalmology Research: An International Journal
Background- The primary goal of cataract extraction surgery is immediate visual recovery and the best uncorrected visual acuity (UCVA) post operatively. Aim: To compare the surgically induced astigmatism (SIA) after phacoemulsification surgery with superior clear corneal incision (SCCI) and temporal clear corneal incision (TCCI). Materials & method: 11 articles were reviewed on PubMed related to SIA & a review was made on the factors that are responsible to reduce the post-operative astigmatism. The outcome measures were SIA and UCVA at 2 and 6 weeks, post‐operatively. Results - In this study we expect to have better visual outcome and reduce incidence of SIA in TCCI than SCCI. Conclusion: TCCI appears to have better visual outcome and reduced incidence of SIA.
Analysis of Corneal Astigmatism after Clear Corneal Phacoemulsification : A Prospective Study
Birat Journal of Health Sciences, 2020
Introduction: With the evolution of cataract surgery over the past years and increasing patient demand for spectacle independence, today cataract surgery is moreover a refractive surgery. Surgically induced astigmatism (SIA) hinders post-operative refractive precision by changing the refractive power of cornea. Objectives: To calculate and compare SIA and postoperative spherical equivalent (SE) among eyes undergoing phacoemulsification performed via superior and temporal approach. Methodology: A longitudinal prospective observational study was conducted in a tertiary eye care center. 200 consecutive patients who underwent 2.8mm clear corneal phacoemulsification were allocated in Group A (Superior) and Group B (Temporal) in equal numbers by random lotiery method. Patients with any corneal pathology, glaucoma, retina or macular diseases, with previous history of trauma or ocular surgery were excluded. Preoperative astigmatism, postoperative astigmatism and postoperative SE were calcul...
2020
Background : Cataract is still one of the eye health problem. Blindness due to cataract can be prevented with cataract surgery so the vision can be corrected. Cataract surgery have huge development and now phacoemulsification is used widely. Surgically induced astigmatism is one of many tools to evaluate the success of cataract surgery. Surgically induced astigmatism will affect visual acuity. There are many factors contributing the incident of surgically induced astigmatism such as size of incision, location of incision, and pre surgery astigmatism. Objective : to analyze surgically induced astigmatism after cataract surgery with 2.75 mm temporal clear corneal incision phacoemulsification technique. Material and Methods : Cross-sectional studies has been conducted on 92 subject. Astigmatism were evaluated in every subject before and after cataract surgery. Surgically induced astigmatism were evaluated by evaluating keratometry before and after cataract surgery. Comparative statisti...
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.10\_Oct2019/Abstract\_IJRR0022.html, 2019
Over the years cataract surgery has undergone & is undergoing continuous refinements as it is one of the most gratifying rehabilitative (and curative at the same time) procedure in the medical practice. But what has not changed over the period is association of postoperative astigmatism with cataract surgery & uphill task for ophthalmologists to minimize it. In recent years, the evolution of the cataract operation has involved a progressive decrease in size of the incision for the extraction of the degenerated crystalline lens. Practically we have manual small incision cataract surgery (MSICS), Coaxial Phacoemulsification, Micro-Coaxial Phacoemulsification and Bimanual Microincision cataract surgery (B-MICS) in our hand to give our patients best possible visual outcome in terms of lesser and lesser astigmatism. 120 patients were selected for this study and divided in six groups. Within each group, each surgical technique was kept nearly constant and patients requiring an intraoperative alteration in the techniques were omitted from the study. Postoperatively, only those cases were kept in the study that did not have any confounding factors like postoperative inflammation that could have a bearing on visual outcome and corneal astigmatism. Dosage of topical steroids was also kept constant (i.e. 4 times daily in 1 st week, 3 times daily in 2 nd week, and 2 times daily in 3 rd week) post-operatively. All other possible factors were kept constant. Neither age nor sex proved to be statistically significant in either of 6 groups across the study. All patients were examined pre-operatively and post-operatively (on day 1 and 7 and at 1 and 3 months) to note keratometric (K1and K2) values and to calculate preop. and postop. astigmatism. All data was carefully accumulated, arranged and assessed statistically to derive significant conclusions using appropriate statistical method. In our study SIA was studied for evolution, stability and its magnitude in 6 study group: Surgically induced astigmatism was calculated using SIA Calculator based on the method of Holladay et al i.e. converting the pre-operative and post-operative astigmatism values in their components at X axis and at Y axis. Then Cartesian-coordinates is converted into astigmatic vector form.