ASTIGMATISM;

Objectives: To evaluate the management of pre-existing astigmatism with 3.2 mm corneal incision on steeper axis during phacoemulsification cataract surgery. Study Design: Analytical study. Setting: Patients undergoing cataract surgery with phacoemulsification in K.D.A Teaching Hospital KMU-IMS Kohat. Period: January, 2016 to July, 2016. Materials and Methods: 50 patients with age related cataract were selected. Out of them 23 (46%) were male and 27 (54%) were female. All the patients were in age range from 49 to 76 years with mean age of 63.2% years. Proper examination with slit lamp was done. Informed consent was obtained from each patient. Proper proforma was made for documentation. Biometry was done for IOL power. Preoperative keratometry was done with Topcon autoref-keratometer. Patients with traumatic eyes, previously operated eyes, vascularised and opacified cornea were excluded from the study. Pupils of patients were dilated properly with tropicamide eye drop. Phacoemulsification with 3.2 mm clear corneal incision at steeper axis with intraocular lenses implantation was carried out on all patients by single surgeon under topical anesthesia. Postoperative keratometry was done on the same keratometer and observer to avoid bias at the end of two months. Results: Preoperative astigmatism was present in range of 0.12 diopter cylinder to 3.71 diopter cylinder with mean 1.56 diopter cylinder. At the end of two months mean astigmatism of 0.98 diopter cylinder with range 0.2 diopter cylinder to 2.0 diopter cylinder was noted postoperatively with mean reduction of 0.58 diopter cylinder. Conclusion: Phacoemulsification with 3.2 mm clear corneal incision at steeper axis can correct astigmatism significantly with good emmetropic results.

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Small Incision Cataract Surgery (SICS) with Clear Corneal Incision and SICS with Scleral Incision A Comparative Study

Delta Medical College Journal ◽

10.3329/dmcj.v2i1.17793 ◽

2014 ◽

Vol 2 (1) ◽

pp. 22-27

Author(s):

Md Shafiqul Alam ◽

Khaleda Nazneen Bari

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Visual Outcome ◽

Small Incision Cataract Surgery ◽

Corneal Incision ◽

Clear Corneal Incision ◽

Age Related ◽

Postoperative Astigmatism ◽

Group A ◽

Group B

Background: Age related cataract is the leading cause of blindness and visual impairment throughout the world. With the advent of microsurgical facilities simple cataract extraction surgery has been replaced by small incision cataract surgery (SICS) with posterior chamber intra ocular lens implant, which can be done either with clear corneal incision or scleral incision. Objective: To compare the post operative visual outcome in these two procedures of cataract surgery. Materials and method: This comparative study was carried out in the department of Ophthalmology, Delta Medical College & Hospital, Dhaka, Bangladesh, during the period of January 2010 to December 2012. Total 60 subjects indicated for age related cataract surgery irrespective of sex with the age range of 40-80 years with predefined inclusion and exclusion criteria were enrolled in the study. Subjects were randomly and equally distributed in 2 groups; Group A for SICS with clear corneal incision and group B for SICS with scleral incision. Post operative visual out come was evaluated by determining visual acuity and astigmatism in different occasions and was compared between groups. Statistical analysis was done by SPSS for windows version12. Results: The highest age incidence (43.3%) was found between 61 to 70 years of age group. Among study subjects 40 were male and 20 were female. Preoperative visual acuity and astigmatism were evenly distributed between groups. Regarding postoperative unaided visual outcome, 6/12 or better visual acuity was found in 19.98% cases in group A and 39.6% cases in group B at 1st week. At 6th week 6/6 vision was found in 36.3% in Group A and 56.1% in Group B and 46.2% in group A and 66% in group B without and with correction respectively. With refractive correction, 6/6 vision was attained in 60% subjects of group A and 86.67% of group B at 8th week. Post operative visual acuity was statistically significant in all occasions. Postoperative astigmatism of >0.50D was in 82.5% subjects of group A and 52.8% subjects of group B at 1st week. At 6th week postoperative astigmatism of less than 1D was in 79.95% subjects of Group A and 83.34% subjects of Group B. About 20% subjects in Group A and only 3.3% in Group B showed astigmatism of more than 1D and these differences on both the occasions were statistically significant. Conclusion: The post operative visual outcome was better in SICS with scleral incision (group B) than in SICS with clear corneal incision (Group-A). DOI: http://dx.doi.org/10.3329/dmcj.v2i1.17793 Delta Med Col J. Jan 2014; 2(1): 22-27

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Two Different Corneal Incision Designs for Correcting Corneal Astigmatism During Cataract Surgery With Multifocal Intraocular Lens Implantation

10.21203/rs.3.rs-460872/v1 ◽

2021 ◽

Author(s):

Dan Liu ◽

Cong Fan ◽

Chunyan Li ◽

Jian Jiang

Keyword(s):

Cataract Surgery ◽

Corneal Astigmatism ◽

Intraocular Lenses ◽

Corneal Incision ◽

Multifocal Iol ◽

Clear Corneal Incision ◽

Corneal Aberrations ◽

Multifocal Intraocular Lenses ◽

Post Surgery ◽

The Mean

Abstract Background: Multifocal intraocular lenses (IOLs) is very intolerant to residual corneal astigmatism and patients with more than 1.0 D of residual corneal astigmatism are not suitable candidates for implantation of multifocal IOLs. The purpose of this study was to evaluate the efficacy of a single clear corneal incision (CCI) or an opposite clear corneal incision (OCCI) made on a steep meridian for correction of low to moderate corneal astigmatism during implantation of multifocal IOLs.Methods: This is a retrospective cohort study. A total of 50 patients with pre-operative total corneal astigmatism, ranging between 0.5 and 2.0 diopters (D), who underwent cataract surgery and received multifocal IOLs were included. Correction of corneal astigmatism was done via single CCIs on steep meridians in patients with 0.5–1.2 D total corneal astigmatisms, and OCCIs in patients with 1.3–2.0 D total corneal astigmatisms. Visual acuity, corneal astigmatism, ocular aberrations, corneal aberrations, and subjective vision quality were evaluated after surgery.Results: At 12-weeks post-surgery, the mean uncorrected distance vision (UCDV) was 0.06±0.09 logarithm of the minimum angle of resolution (logMAR) and 0.03±0.09 logMAR, and the mean uncorrected near vision (UCNV) was 0.08±0.11 logMAR and 0.09±0.09 logMAR in the CCI and OCCI groups, respectively. The change in corneal astigmatism was 0.52 ± 0.22D and 1.06 ± 0.23D in the CCI and OCCI groups, respectively (P<0.001). Total corneal higher-order aberrations (HOAs) and trefoil increased in both groups (P<0.05); however, there was no difference in the change in total corneal HOAs between the two groups (P>0.05). Conclusions: CCI and OCCI made on a steep axis could be an option for correction of mild-to-moderate astigmatism during cataract surgery with multifocal IOL implantation.

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Changes in ocular astigmatism after superotemporal versus temporal clear corneal incision cataract surgery

10.21203/rs.3.rs-311232/v1 ◽

2021 ◽

Author(s):

Qi Fan ◽

Dongjin Qian ◽

Zhennan Zhao ◽

Yongxiang Jiang ◽

Yi Lu

Keyword(s):

Cataract Surgery ◽

Anterior Segment ◽

Corneal Astigmatism ◽

Corneal Incision ◽

Clear Corneal Incision ◽

Ocular Residual Astigmatism ◽

Age Related ◽

Postoperative Astigmatism ◽

Manifest Refraction ◽

Uncorrected Visual Acuity

Abstract Background The incision site to choose to manage postoperative astigmatism during cataract surgery is still debated. This study investigated corneal and internal astigmatism changes after superotemporal versus temporal clear corneal incision cataract surgery. Methods Patients included were diagnosed between December 2019 and January 2020 with age-related cataract with corneal astigmatism < 1.5 diopters (D) and were divided into two groups: Right Eye Group (R Group, superotemporal incision) and Left Eye Group (L Group, temporal incision). Uncorrected visual acuity, manifest refraction, corneal topography, anterior segment optical coherence tomography were performed pre- and 6 months postoperatively. Total ocular astigmatism, corneal astigmatism, surgically induced corneal astigmatism (SICA), non-corneal ocular residual astigmatism (N-CORA), postoperative intraocular lens (IOL) decentration, and tilt were analysed. Results Thirty-eight subjects were included: 21, R Group; 17, L Group. After surgery, the N-CORA decreased significantly from 1.17 ± 0.72D to 0.73 ± 0.47D in all patients (P = 0.001), 1.03 ± 0.52D to 0.70 ± 0.40D in the R Group (P = 0.005), and 1.35 ± 0.90D to 0.78 ± 0.55D in the L Group (P = 0.033). Significant differences between the R and L groups were found in the postoperative meridian of anterior corneal astigmatism (75.95 ± 52.50 vs 116.79 ± 47.29; P = 0.017), total corneal astigmatism (51.65 ± 42.75 vs 95.20 ± 57.32; P = 0.011), J45 change vector of SICA in the anterior cornea (-0.10 ± 0.18 vs 0.00 ± 0.11; P = 0.048), and total cornea surface (-0.14 ± 0.17 vs 0.03 ± 0.12; P = 0.001). IOL decentration, tilt, and the meridian of IOL tilt were not significantly correlated with N-CORA. Conclusions The N-CORA significantly decreased after cataract surgery. Superotemporal and temporal incisions can cause differences in the meridian components of oblique astigmatism but will not have a significant effect on the magnitude of corneal astigmatism.

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Minimizing Surgically Induced Astigmatism at the Time of Cataract Surgery Using a Square Posterior Limbal Incision

Journal of Ophthalmology ◽

10.1155/2011/243170 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Paul Ernest ◽

Warren Hill ◽

Richard Potvin

Keyword(s):

Cataract Surgery ◽

Corneal Astigmatism ◽

Intraocular Lenses ◽

Corneal Incision ◽

Surgically Induced Astigmatism ◽

Clear Corneal Incision ◽

Refractive Outcomes ◽

Induced Astigmatism ◽

Surgically Induced ◽

Corneal Incisions

Purpose. To compare the surgically induced astigmatism from clear corneal and square posterior limbal incisions at the time of cataract surgery.Methods. Surgically induced astigmatism was calculated for a set of eyes after cataract surgery using a temporal 2.2 mm square posterior limbal incision. Results were compared to similar available data from surgeons using clear corneal incisions of similar size.Results. Preoperative corneal astigmatism averaged 1.0 D and was not significantly different between the incision types. Surgically induced astigmatism with the 2.2 mm posterior limbal incision averaged0.25±0.14 D, significantly lower in magnitude than the aggregate surgically induced astigmatism produced by the 2.2 mm clear corneal incision (0.68±0.49 D).Conclusion. The 2.2 mm square posterior limbal incision induced significantly less, and significantly less variable, surgically induced astigmatism relative to a similar-sized clear corneal incision. This is likely to improve refractive outcomes, particularly important with regard to premium intraocular lenses.

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Comparison of posterior capsule opacification between Clareon CNA0T0 and Tecnis ZCB00 intraocular lenses

European Journal of Ophthalmology ◽

10.1177/1120672121991718 ◽

2021 ◽

pp. 112067212199171

Author(s):

Cristina Almenara ◽

Francisco de Asís Bartol-Puyal ◽

Diana Soriano ◽

Miriam Idoipe ◽

María Chacón ◽

...

Keyword(s):

Posterior Capsule Opacification ◽

Intraocular Lenses ◽

Posterior Capsule ◽

Slit Lamp ◽

Age Related ◽

Corrected Distance Visual Acuity ◽

Iol Power ◽

Group 2 ◽

High Order Aberrations ◽

Group 1

Introduction: The purpose is to compare posterior capsule opacification (PCO) and its impact on vision between Clareon CNA0T0 (Alcon) and Tecnis ZCB00 intraocular lenses (IOLs) (Johnson&Johnson) 1, 6, and 12 months after implantation. Methods: A prospective observational study was performed at the Nuestra Señora de Gracia Hospital (Zaragoza, Spain). Fifty eyes (50 patients) with Tecnis IOL (group 1) and 60 eyes (60 patients) with Clareon IOL (group 2) were enrolled. One, 6, and 12 months after age-related cataract surgery by five different surgeons, the following tests were performed: mesopic corrected distance visual acuity (CDVA), CSV1000-E test, KR-1W wavefront analyzer, OQAS II, Catquest-9SF questionnaire and mydriatic slit-lamp pictures. PCO intensity was quantified and the area of opacification was measured using ImageJ (NIH). Results: Mean age was 71.20 ± 6.79 years in group 1, and 71.73 ± 8.17 years in group 2 ( p = 0.72); mean axial length was 23.46 ± 1.14 and 23.53 ± 0.91 mm, respectively ( p = 0.72); mean IOL power was 21.69 ± 2.26 D and 21.28 ± 2.44 D, respectively ( p = 0.37). One month after surgery there were differences in intensity of PCO (0.73 ± 0.60 and 1.05 ± 0.71, respectively, p = 0.02). Six months after surgery statistical differences were found in VA with 20% CS in mydriatic conditions (0.26 ± 0.21 logMAR (20/36) and 0.18 ± 0.17 logMAR (20/30), respectively, p = 0.04). Twelve months after surgery, no differences were detected between groups. As for the evolution of PCO within the Clareon group, high order aberrations ( p < 0.05) and the Strehl ratio ( p = 0.02) decreased. Conclusion: There are no differences in slit-lamp pictures or visual function between both IOLs during the first 12 months after implantation.

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Toric Intraocular Lenses for the Management of Corneal Astigmatism at the Time of Cataract Surgery

Journal of Ophthalmology ◽

10.1155/2021/3286043 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Colm McAlinden ◽

David Janicek

Keyword(s):

Cataract Surgery ◽

Human Error ◽

Data Entry ◽

Corneal Astigmatism ◽

Intraocular Lenses ◽

Vector Analysis ◽

Corneal Incision ◽

Toric Iol ◽

Iol Power ◽

The Mean

Aims/Background. To assess astigmatic outcomes with the use of toric intraocular lenses (IOLs) for patients with significant amounts of corneal astigmatism undergoing cataract surgery. Methods. This audit was conducted in a UK ophthalmology department and included 48 eyes of 42 patients. Surgery was performed during 2019 in patients with 2.50 diopters (D) or more corneal astigmatism. Anterior keratometry readings were used to determine the toric IOL power. Vector analysis using the Alpins method was used to assess changes in astigmatism pre to postoperatively. Results. There were 18 right and 26 left eyes included. In terms of gender, 61% of patients were female and 39% were male. The mean (±standard deviation (SD)) age was 70 (±11) years. The mean (±SD) axial length, K1, K2, and delta K was 23.55 (±1.4) mm, 42.71 (±1.39) D, 45.78 (±1.60) D, and 3.01 (±0.89) D, respectively. Postoperatively, the median spherical, cylinder, and spherical equivalent refraction was 0.00 D, −1.00 D, and 0.00 D, respectively. Postoperatively, 41% of the eyes had ≤0.50 D of spectacle astigmatism and 80% had ≤1.00 D. No patient required a secondary procedure to reposition the IOL from rotation. In vector analysis with the use of polar diagrams, there was a tendency for overcorrection of with-the-rule astigmatism and undercorrection of against-the-rule astigmatism. Conclusions. Significant reductions in astigmatism can be achieved with the use of toric IOLs in patients undergoing cataract surgery. Further improvements may be possible with surgeon-specific determination of their surgically induced astigmatism and flattening effect from the main corneal incision. Furthermore, the use of an optical biometer that directly measures the posterior corneal curvature and permits automatic toric IOL power determination with modern formulas avoiding the need for manual data entry may reduce the risk of human error and improve visual and refractive outcomes.

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Two Different Corneal Incision Designs for Correcting Corneal Astigmatism During Cataract Surgery With Multifocal Intraocular Lens Implantation

10.21203/rs.3.rs-460872/v2 ◽

2021 ◽

Author(s):

Dan Liu ◽

Cong Fan ◽

Chunyan Li ◽

Jian Jiang

Keyword(s):

Cataract Surgery ◽

Corneal Astigmatism ◽

Intraocular Lenses ◽

Corneal Incision ◽

Multifocal Iol ◽

Clear Corneal Incision ◽

Corneal Aberrations ◽

Multifocal Intraocular Lenses ◽

Post Surgery ◽

The Mean

Abstract Background: Multifocal intraocular lenses (IOLs) is very intolerant to residual corneal astigmatism and patients with more than 1.0 D of residual corneal astigmatism are not suitable candidates for implantation of multifocal IOLs. The purpose of this study was to evaluate the efficacy of a single clear corneal incision (CCI) or an opposite clear corneal incision (OCCI) made on a steep meridian for correction of low to moderate corneal astigmatism during implantation of multifocal IOLs.Methods: This is a retrospective cohort study. A total of 80 patients with pre-operative total corneal astigmatism, ranging between 0.5 and 2.0 diopters (D), who underwent cataract surgery and received multifocal IOLs were included. Correction of corneal astigmatism was done via single CCIs on steep meridians in patients with 0.5–1.2 D total corneal astigmatisms, and OCCIs in patients with 1.3–2.0 D total corneal astigmatisms. Visual acuity, corneal astigmatism, ocular aberrations, corneal aberrations, and subjective vision quality were evaluated after surgery.Results: At 12-weeks post-surgery, the mean uncorrected distance vision acuity (UDVA) was 0.06±0.09 logarithm of the minimum angle of resolution (logMAR) and 0.03±0.09 logMAR, and the mean uncorrected near vision acuity(UNVA) was 0.08±0.11 logMAR and 0.09±0.09 logMAR in the CCI and OCCI groups, respectively. The change in corneal astigmatism was 0.52 ± 0.22D and 1.06 ± 0.23D in the CCI and OCCI groups, respectively (P<0.001). Total corneal higher-order aberrations (HOAs) and trefoil increased in both groups (P<0.05); however, there was no difference in the change in total corneal HOAs between the two groups (P>0.05). Conclusions: CCI and OCCI made on a steep axis could be an option for correction of mild-to-moderate astigmatism during cataract surgery with multifocal IOL implantation.

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