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Cataract surgery and management of corneal astigmatism

Poster Details

First Author: M.Karafyloglou GREENLAND

Co Author(s):    F. Akritidoy   D. Karamanis           

Abstract Details



Purpose:

To determine the incidence of surgically induced astigmatism during the transition from standard extracapsular techniques to clear cornea phacoemulsification and to present options for the intraoperative management of astigmatism in order to achieve optimal postoperative vision.

Setting:

Department of Ophthalmology, General Hospital of Kavala, Kavala, Greece

Methods:

Medical records during the transitional period from standard extracapsular techniques to phacoemulsification (2010 - 2012) were retrospectively analyzed. The incidence of surgically induced astigmatism was determined using postoperative refractional function testing (both subjective and objective). Postoperative cylinder power (total astigmatism) was recorded. 23 patients underwent cataract surgery with simultaneous astigmatism correction. The surgical wound was placed along the steep axis of astigmatism in 12 cases (range of preoperative astigmatism: 1 to 1.5D) and an intraocular posterior chamber (PC) toric lens was inserted in 11 cases (range of preoperative astigmatism up to 2.75D).

Results:

In 2010, 66% of the patients underwent phacoemulsification while 34% had extra capsular cataract extraction (ECCE) with PC intraocular lens (IOL). In 2011 75% had phacoemulsification and 25% ECCE. In 2012 85% had phacoemulsification and 15% ECCE. All patients were examined one month after surgery. In 2010 53% presented surgically induced astigmatism (SIA) up to 2,25D, in 2011 39% presented SIA with maximum value at 2,5D while in 2012 only 27% of cases had SIA up to 2D. The mean value of postoperative astigmatism was also significantly reduced due to small incision suture-less techniques. 4 weeks after surgery, SIA mean value was 1.5D in 2010, 1D in 2011 and 0,50D in 2012. With regards to the 23 cases of intraoperative correction of astigmatism, wound placement along the steep axis caused a reduction of 0,50D. Toric lens use caused a more significant reduction of astigmatism (residual astigmatism up to 0,50D was noted in 3 out of total 11 cases).

Conclusions:

The incidence of SIA was significantly reduced as phacoemulsification became the preferred method for cataract surgery and surgical ability improved. In patients with little (<0.75 D) or no preexisting astigmatism, cataract surgery should be as astigmatically neutral as possible. In patients with significant preexisting astigmatism there are different intraoperative options that permit astigmatism correction along with cataract surgery. In conclusion patients can achieve very good visual acuity and spectacle independence with modern cataract surgery techniques. FINANCIAL INTEREST: NONE

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