Hyun Seung Kim, M.D.

1
Changes in Astigmatism After Clear Corneal
Temporal Incision Cataract Surgery in
With-The-Rule Astigmatism Patient

• Hyun Seung Kim, M.D.
• Department of Ophthalmology, St. Marys hospital,
  
• The Catholic University of Korea

2
Introduction

• Inserting the IOL in the bag
• Capsule bag diameter lt Total IOL length
• ? Angulation between IOL optic and haptic may
  occur
• ? IOL angulation might induce astigmatism
• perpendicular to the inserted axis.

3
Purpose

• This study is to compare changes of with-the-rule
  astigmatism after clear corneal temporal incision
  cataract surgery in with-the-rule astigmatic
  patients.
• Suturing temporal incision vs. not suturing
• IOL haptic insertion at 180 vs. 90 axis

4
Materials and Methods

• 47 patients (49 eyes) with grade 3 cataract
• Operation procedure
• 3 mm clear corneal temporal incision with a
  diamond blade
• Phacoemulsification of the lens nucleus was
  performed with phacoemulsifier (Infiniti, Alcon,
  USA).
• IOL (One-piece AcrySof, SA60AT, Alcon
  Laboratories, Forth Worth, TX, USA total length
  13.0 mm) was inserted in the bag.
• After placing the IOL in the bag, IOL rotation
  was performed to place the haptic axis at 180or
  90.
• IOL haptic insertion axis was randomly selected.
• Incision suture was performed with 10-0 nylon
  (one radial suture), randomly. It was removed at
  postoperative 1 month.

5
Materials and Methods

• Patients were divided into four groups according
  to IOL haptic insertion axis and incision suture
• Group I IOL haptic axis at 180 Incision
  suture done.
• Group II IOL haptic axis at 90 Incision
  suture done.
• Group III IOL haptic axis at 180 Incision
  suture not done.
• Group IV IOL haptic axis at 90 Incision
  suture not done.
• Astigmatic changes were compared by Autorefractor
  (BK-F1, Canon) and Topography (Orbscan II,
  Orbtek) at preoperative and postoperative 1 day,
  1 week, 1 month, 2 months.
• Pupil dilatation was done at postoperative 1
  month and patients with IOL rotation from the
  original insertion axis were excluded from the
  study.

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Dermographics and preoperative astigmatism
Group I Group II Group III Group IV P-value
Eye 12 11 12 14
Age 59.3611.79 45.6016.86 55.6712.32 58.5713.59 0.319
Gender ( F M ) 7 5 5 6 8 4 6 8
Autorefractor Cylinder (D) 1.701.38 1.430.76 0.960.91 1.531.36 0.461
Topography Sim Ks (D) 1.670.52 1.020.62 0.880.54 1.480.26 0.110
7
Results Suture vs. No suture
Suture Group (Group III) No suture Group (Group IIIIV) P-value
Autorefractor Preoperative Postoperative 1 day Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.541.10 1.250.68 1.090.69 1.200.88 1.200.86 1.271.13 1.401.30 1.231.09 1.291.06 1.331.02 0.971 0.016 0.026 0.808 0.061
Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.551.15 1.350.89 1.520.93 1.440.90 1.210.79 1.531.07 1.511.08 1.491.11 0.466 0.036 0.585 0.446
8
Results Suture vs. No suture

• Topography Corneal astigmatism tends to
  increase in no suture group, as an relaxing
  effect of temporal incision. There are no
  statistical significance between two groups,
  except at postoperative 1 week (A).
• Autorefractor Refractive astigmatism tends to
  decrease in suture group at postoperative 1 day,
  1 week, 1 month and 2 months. Astigmatism showed
  significant difference between two groups at
  postoperative 1 day and 1 week, but it showed no
  difference at postoperative 1 month and 2 months
  (B).

9
Results Haptic 180vs. Haptic 90
Haptic 180 (Group IIII) Haptic 90 (Group IIIV) P-value
Autorefractor Preoperative Postoperative 1 day Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.321.17 1.281.00 1.000.73 1.010.77 1.010.81 1.461.09 1.391.15 1.341.09 1.491.11 1.531.30 0.971 0.621 0.051 0.050 0.048
Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.401.14 1.340.88 1.420.95 1.290.97 1.300.79 1.561.11 1.611.07 1.651.05 0.466 0.537 0.585 0.446
10
Results Haptic 180vs. Haptic 90

• Topography There are no statistical difference
  between two groups (A).
• Autorefractor Refractive astigmatism of group
  with IOL haptic insertion axis at 180showed
  significant difference compared to the group with
  IOL haptic insertion axis at 90at postoperative
  1 week, 1 month and 2 months. It was also
  significantly decreased in group with IOL haptic
  axis at 180compared with preoperative
  astigmatism at postoperative 1 week, 1 month and
  2 months (B).

11
Results Group comparison
Group I Group II Group III Group IV
Autorefractor Preoperative Postoperative 1 day Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.701.38 1.320.75 1.230.76 1.250.83 1.250.74 1.430.76 1.170.59 0.920.56 1.140.94 1.140.98 0.960.91 1.251.18 0.790.65 0.790.65 0.790.82 1.531.36 1.541.38 1.611.25 1.711.15 1.791.41
Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.670.52 1.501.00 1.671.08 1.531.08 1.020.62 1.160.69 1.340.67 1.320.59 0.880.54 1.200.73 1.180.75 1.070.78 1.480.26 1.811.23 1.791.23 1.861.22
12
Results Group comparison
13
Conclusions

• When performing cataract surgery in with-the-rule
  astigmatism patients
• Suturing the temporal incision may reduce WTR
  astigmatism comapred with not suturing the
  incision.
• Inserting the IOL haptic axis at 180may have an
  effect of reducing WTR astigmatism compared with
  IOL inserted at 90 axis.
• Further clinical study is needed.
• Compare the results with ATR astigmatic patients.
• Difference between angulation of IOL haptic
  inserted at 90or 180and difference between IOL
  types.