Evaluation of Opposite Clear Corneal Incision in Controlling Astigmatism in Cataract Patients Undergoing Phacoemulsification Surgery

Abstract

Aim: To evaluate the role of clear corneal incision combined with opposite clear corneal incision in controlling astigmatism in patients undergoing phacoemulsification surgery for cataract. Design: Prospective clinical study. Methods: 45 consecutive patients planned for phacoemulsification were divided into three equal groups of fifteen patients each: Group 1 presenting without corneal astigmatism, Group 2 having WTR (with-the-rule) and Group 3 having ATR (against-the-rule) astigmatism. All underwent phacoemulsification through 2.8mm clear corneal incision. In Group 1 the temporal clear corneal incision (CCI) was enlarged to 3.2mm before IOL insertion along with 2.2mm superior CCI to neutralise the astigmatism induced by main cataract incision. In Group 2 the superior CCI was enlarged to 3.2mm before IOL insertion, followed by 3.2mm inferior opposite CCI. In Group 3 the temporal CCI was enlarged to 3.2mm before IOL insertion followed by 3.2mm nasal opposite CCI. Results: In Group 1, the overall mean postoperative astigmatism observed was 0.28 ± 0.2D WTR, with 4 out of 15 patients (26.66%) continuing to have nil astigmatism. In Group 2, the mean postoperative astigmatism was reduced from 1.16 ± 0.32D WTR preoperatively, to 0.46 ± 0.28D WTR at 3 months postoperatively. In Group 3, the preoperative astigmatism of -1.25 ± 0.32DATR reduced to -0.38 ± 0.31D ATR, 3 months postoperatively. The reduction in astigmatism was statistically significant in both WTR and ATR astigmatism groups (p < 0.001). Conclusion: More than 50% reduction in astigmatism was achieved in both groups with astigmatism. Thus opposite clear corneal incision (OCCI) is a simple, predictable, safe and effective procedure in reducing mild to moderate preexisting corneal astigmatism in cataract surgery.