Astigmatism after phacoemulsification with adjusted and unadjusted sutured versus sutureless 5.2 mm superior scleral incisions

Abstract

Purpose: To evaluate changes in astigmatism in the first 6 months after 5.2 mm superior scleral incision phacoemulsification using three different closures.Setting: Department of Ophthalmology, Vejle Hospital, Denmark.Methods: This study comprised 75 consecutive patients who had 5.2 mm superior scleral incision phacoemulsification. Patients were randomly assigned to one of three groups based on type of incision closure: Group 1, one intraoperatively adjusted cross suture; Group 2, one unadjusted cross suture; Group 3, no suture. Inclusion criteria were preoperative astigmatism of 2.00 diopters (D) or less (range of median 0.74 to 0.81 D) and no eye disease except cataract. Postoperative astigmatism was evaluated by keratometric cylinder, induced astigmatism (Naeser), and induced cylinder (Jaffe) on the first day and after 1 week and 1, 3, and 6 months. Time before stability was estimated.Results: All groups had the same level of postoperative keratometric cylinder with no significant change between 1 week and 6 months (range of median 0.81 to 1.06 D). The groups reached the same level of induced astigmatism (Naeser) 3 to 6 months after surgery (range of median −0.44 to −0.64 D). Group 3 (sutureless) reached that value after 1 week, and induced astigmatism was stable thereafter. Both sutured groups (Groups 1 and 2) had a highly significant change between the first week and third month (P < .01). There were no significant intergroup differences in induced cylinder (Jaffe), which stabilized after 1 week in Groups 1 and 2 and after 1 month in Group 3 (range of median 0.61 to 0.87 D). During the early postoperative period, variation was highest in Group 2.Conclusions: Keratometric cylinder, induced astigmatism, and induced cylinder 3 to 6 months postoperatively were similar among the three groups, but early stability was only seen in the sutureless group. If a suture is used, intraoperative adjustment seems to result in lower variations in the early postoperative period.