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Comparing Surgical-Induced Astigmatism through Change of Incision Site in Manual Small Incision Cataract Surgery (SICS)

Ahmad Abdelmegid Radwan

Purpose: To compare the astigmatism induced by a superior versus temporal incision in manual small incision cataract surgery (SICS) in eyes with preoperative "with the rule" corneal astigmatism (WTR).
 
Methods: A prospective comparative study was carried on 35 eyes of 24 patients. All of them had senile cataract and were selected from "Ain Shams university hospitals" ophthalmology outpatient clinic. The patients were subdivided into 2 groups according to site of incision. Group A: 18 eyes (of 13 patients) underwent SICS through superior approach with implantation of PMMA IOL. Group B: 17 eyes (of 11 patients) underwent SICS through temporal approach with implantation of PMMA IOL. The SIA was then calculated for each eye (at day 45 postoperative) and compared.
 
Results: Mean surgical-induced astigmatism (SIA) was found to be significantly lower in the temporal group compared to that in the superior group (P<0.01). The superior incision induced 2.1 D of "against the rule astigmatism (ATR)". While the temporal incision induced 0.7 D of WTR astigmatism.
 
Conclusion: The high SIA induced by superior incision may prove useful when aimed at reducing high levels of preoperative corneal WTR astigmatism (around 2 D). On the other hand, temporal incision is recommended in patients with low levels of preoperative WTR astigmatism. The exact cut-off value is to be studied.