Sudden Against-the-Rule Astigmatism 6 Months after Intraocular Lens Implantation with the Kelman Phacoemulsification Procedure: 4 of 809 Cases

Abstract

Of 809 eyes that underwent the Kelman phacoemulsification and aspiration (KPE) procedure, we report on 4 patients (0.49%) who developed sudden against-the-rule (AR) astigmatism after intraocular lens implantation. These patients had had with-the-rule astigmatism preoperatively to 3 months postoperatively and suddenly developed AR astigmatism 6 months after surgery. To study the development and progression of AR astigmatism in these patients (group A), we compared their 6-month time course with that of 257 patients (group B) with postoperative AR astigmatism. In group A, the degree of astigmatism was not significantly different from group B astigmatism preoperatively (1.03 +/- 0.16 vs. 1.04 +/- 0.04 dptr) and 6 months postoperatively (1.32 +/- 0.13 vs. 1.26 +/- 0.05 dptr). However, 1 week postoperatively, the astigmatism of the 4 cases was much greater (5.72 +/- 0.14 dptr) than that of the others (2.32 +/- 0.07 dptr). These rare 4 cases, which had no other unusual characteristics, are indicative of the importance of a careful follow-up even if the post-KPE course seems uneventful.