Frown Incision Research Articles

Comparison of Mean Surgically Induced Astigmatism in Manual Small Incision Cataract Surgery Using Frown Vs Chevron Incision

Purpose: To compare the mean surgically induced Astigmatism(SIA) in Manual Small Incision Cataract Surgery (MSICS) using frown (inverted U) versus inverted V (chevron) incision. Study Design: Quasi experimental study. Place and Duration of Study: Hayatabad Medical Complex from 27th July 2018 to 27th January 2019. Methods: This study included 148 patients who were distributed into the Frown group (F) and Chevron group (C) by convenient sampling. Each group had 74 patients through block operative randomization. To eliminate bias, all the surgeries were performed by one surgeon having more than 5 years’ experience of MSICS. Pre-operative and Post operative keratometric readings were taken. SIA calculator was utilized, and data was analyzed through SPSS 26. Means and standard deviation for continuous variables like age and surgically induced astigmatism were calculated. Results: In Group F, mean surgically induced astigmatism was 1.14±0.65D and in Group C it was 0.87±0.55D. The independent T test revealed that the mean SIA was significantly lower in the Chevron group compared to the Frown group.The post operative visual acuities showed that the proportion of patients with postoperative 6/6 vision in the Chevron group was more as compared to group F. Conclusion: Chevron (inverted V) incision induces less postoperative mean surgically induced astigmatism than Frown (inverted U) incision in Manual Small Incision Cataract Surgery. These findings may have implications for cataract surgery techniques and may help in reducing postoperative astigmatism.

"Stamp the tunnel"- Innovative tool - for perfection in manual small incision cataract surgery.

Manual small incision cataract surgery (SICS) is a cost-effective and safe procedure offering comparable outcomes to phacoemulsification. It holds significance for outreach and economically disadvantaged patients in developing countries, while also being important for complex cataracts in developed nations. The SICS technique revolves around a three planar self-sealing sclero corneal tunnel (SCT), a critical element for rapid and suture-less healing. The tunnel's components include the incision, side pocket, internal entry, and depth each affecting astigmatism and successful nucleus delivery.[1-3] Various incision types are explored, with the frown incision yielding minimal astigmatism but posing challenges.[2,4] Inappropriate SCT leads on to high induced astigmatism, post op hypotony, and chances of infection. This video introduces "Tunnel stamp" which is a novel device designed to guide the incision length, internal entry line, and side pocket accuracy thus making a perfect SCT particularly for novice surgeons, who often encounter intraoperative and postoperative complications due to inappropriate SCT. The device is produced through 3D printing with thermoplastic polyurethane (TPU), an easily available and economically feasible material. The prototype's practicality is demonstrated through successful wet lab trials on goat eyes and subsequently on human eyes. The device is aligned using a limbus-matching step and a sterilized marker pen. This device has unique advantage to take care of the three aspects of SCT, that is, incision, side pocket, and internal entry. One can have custom-made guarded knife to perform scleral groove in optimum depth, which is another important dimension of SCT. Future developments involve creating the tunnel stamp in transparent flexible silicon to enhance alignment accuracy. Given the diversity of cataract types, multiple sizes of the device are envisioned to accommodate nucleus size variability and different stages of cataract development. To aid novice surgeons, two variations of incision guides (straight and frown) are proposed for immature and harder cataracts reducing induced astigmatism. Overall, this innovative tunnel stamp aims to enhance SICS outcomes, enabling more precise and consistent SCT creation while addressing challenges posed by various cataract types and surgeon experience levels. https://youtu.be/yzV-UC4jwPg.

Descemet stripping automated endothelial keratoplasty via a frown incision.

To assess the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) via a sclerocorneal frown incision. Retrospective comparative study. The outcomes of Descement stripping endothelial keratoplasty (DSAEK) were retrospectively compared between 36 patients (36 eyes) who underwent surgery via a 3.8-mm frown incision (frown incision group) and 20 patients (20 eyes) who underwent surgery via a 4.6-mm straight incision (straight incision group). In all patients, an NS Endo-Inserter was used as the graft inserter and the incision for a frown incision was via the superior sclerocorneal site and for the straight incision via the temporal cornea. DSAEK was performed by the standard technique, except for the incision. At 1 year after surgery, the two groups were compared with respect to the visual acuity, decrease of corneal endothelial cell density, the severity of corneal astigmatism (diopters), the number of sutures for wound closure, and intraoperative/postoperative complications. There was no significant difference between the two groups in terms of postoperative visual acuity, corneal astigmatism, and intraoperative/postoperative complications one year after surgery. On the other hand, the number of sutures required for wound closure was 1.13±0.42 in the frown incision group, whereas in the straight incision group, it was 3.20±0.40, showing a significant difference (P<0.001). In addition, there was no decreased corneal endothelial cell density associated with the reduction in incision width. A sclerocorneal frown incision is useful for performing DSAEK with an NS Endo-Inserter as it does not affect endothelial cell loss despite its short incision width.

Numerical study of critical straight, frown, and chevron incisions in small incision cataract surgery

Introduction: When an intraocular lens (IOL) injector is inserted through a pre-cut corneal incision (e.g., an empirical size of 2.2 mm) during small incision cataract surgery, uncontrollable tearing to the corneal tissue may occur, which is highly associated with the incision shape, size, and location. The goal of this numerical study was to investigate the optimal incision scheme amongst three typical shapes, i.e., straight, frown, and chevron incisions using mechanical modeling and finite element analysis.Methods: Assuming that the damage is caused by the tissue fracture at the incision tips and is governed by the classical energy release rate (ERR) theory which compares the current ERR value subject to IOL injection and the material’s intrinsic parameter, critical ERR Gc.Results: It was found that for chevron incisions, the incision shape with an angle of 170° was superior which induced minimal ERR value, while for frown incisions, the shape with a central angle of 6° was optimal. Both chevron and frown incisions could allow a larger size of injector to inject through than a straight pre-cut. In particular, the frown incision performed the best due to its lowest corresponding ERR and easy operation.Discussion: It was also observed that regions where the embedded fibrils are more dispersed and exhibit high isotropy were more favorable. If necessary, the chevron incision was recommended to be more aligned with the direction exhibiting a larger modulus, for example, along the circumferential direction near the limbus. This study provides useful knowledge in operation design and a deep insight into mechanical damage to corneal wounds in small incision cataract surgery.

Study of comparison of surgically induced astigmatism after small incision cataract surgery and phacoemulsification surgery

To compare surgically induced astigmatism after manual small incision cataract surgery and phacoemulsification surgery. 2) To know the prevalence of pre-existing astigmatism, it’s magnitude and type and patients with cataract. 3) To calculate the average astigmatism induced after manual small incision cataract surgery and also to know the type of astigmatism and change in it in first month of surgery. 4) To calculate the average astigmatism induced after phacoemulsification surgery and also to know the type of astigmatism and change in its first month of surgery. 5) To study changes in astigmatism and its effect on vision after cataract surgery. 6) To compare astigmatism induced by straight and frown incision after operation.The study was carried out in Department of Ophthalmology, P.D.U government Medical College, Rajkot under guidance of operating surgeons and patients operated in the duration of 24 months from September 2020 to October 2022.Informed consent was obtained from all the patients undergoing study. It was a prospective study and all the patients were randomly selected over the above mentioned period that had cataract with normal anterior and posterior segments. To have a more homogeneous study population all the patients underwent a similar Preoperative, Intra operative, Postoperative Surgical protocols. All eyes were operated under peribulbar anaesthesia with 2% lignocaine+bupivacain+hyalronidase. Superior sclero corneal pocket tunnel with external incision of frown configuration in manual SICS and straight incision in phacoemulsification was made. All the cases with 3.2 mm of incision in phacoemulsification and 6.5 mm incision in manual SICS were taken. Surgically induced astigmatism was then calculated by the subtraction method and vector analysis.Average SIA in SICS was 1.32 SD and in Phacoemulsification was 0.60 SD which means that larger incision size increases SIA. SIA was maximum on first post-operative day and it regressed with time as noted on first post-operative month in both the groups. It decreased from 1.66 D on first postoperative day to 1.32 D on first postoperative month in SICS Patients and from 0.63 D to 0.60 D in Phacoemulsification patient.

Comparative Study of Surgically Section Induced Astigmatism in Manual Small Incision Cataract Surgery

Introduction: Various types of incisions have been adopted and applied in Manual Small Incision Cataract Surgery (MSICS) with the primary objective to attain minimum postoperative Surgically Induced Astigmatism (SIA). Aim: To evaluate and compare the postoperative visual acuity and to determine SIA in Batwing incision and Frown incision in MSICS. Materials and Methods: The present study was a prospective, cross-sectional, interventional, comparative descriptive study in which a total of 380 patients aged 40 years and above with senile, uncomplicated cataract, undergoing MSICS were included. Patients were randomly divided into: Group B (Batwing incision), and Group F (Frown incision). Patients were compared on 6th week postoperatively for Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA) and SIA (performed using SIA Calculator Version 2.1). The data was collected in terms of demographic, clinical and biochemical characteristics that were expressed as range, mean and median and subjected to statistical analysis to obtain results. Results: In group F, total 04 (2.11%) patients showed no astigmatism, 115 (60.53%) patients showed 0-0.5D of SIA, 64 (33.68%) were seen with 0.5-1D of SIA and 07 (3.68%) patients with 1-1.5 D SIA, no patient showed SIA more than 1.5 D. In Group B 01 (0.52%) patient showed no SIA, in 61 (32.11%) 0-0.5D of SIA was seen, in 79 (41.58%) patients 0.5- 1D of SIA was seen and 45 (23.68%) patients had presented with 1-1.5D of SIA while 04 (2.11%) patients with more than 1.5D of SIA. In group F, average preoperative astigmatism preoperatively was 0.55±0.36D and average astigmatism at six weeks postoperatively was 0.46±0.33D. In Group B, average preoperative astigmatism was 0.49±0.39D and average astigmatism six weeks postoperatively was 0.54±0.40D. Conclusion: The present study showed the superiority of Frown incision over Batwing incision in terms of less SIA and improved postoperative unaided visual results.

A clinical study comparing post-operative astigmatism with straight and frown scleral incision in manual small incision cataract surgery

Background: Cataract surgery is considered refractive surgery. Apart from implanting the right dioptric power of Intra ocular lens (IOL), minimizing postoperative astigmatism plays an important role in good visual rehabilitation. Hence, surgical incision is of major importance in minimizing postoperative astigmatism and reducing or abolishing preexisting astigmatism.Objectives: The objective of this study is to compare surgically induced astigmatism (SIA) following straight and frown scleral incisions in manual small-incision cataract surgery (MSICS).Materials and Methods: This is a prospective randomized comparative study conducted among two groups of patients undergoing MSICS, where the straight scleral incision was performed in one group with 29 cases and the frown incision was performed in the other group with 29 cases. Postoperatively, patients were followed up on postoperative day 1, week 1, and week 6. Uncorrected visual acuity, Kv and Kh readings, and SIA were noted at each postoperative visit.Results: SIA on the postoperative day 1 in the straight incision group (SIG) was 1.4914D ± 1.251 and in the frown incision group (FIG) was 0.629D ± 0.288. On the postoperative week 1 in SIG, it was 0.9655D ± 0.699, and in FIG, it was 0.474D ± 0.397. On the postoperative week 6 in SIG, it was 0.8793D ± 0.599, and in FIG, it was 0.414D ± 0.286. SIA was significantly less in FIG compared to SIG (P = 0.011). Postoperative uncorrected visual acuity was better in FIG compared with SIG. More amount the rule astigmatism was noted in FIG on the postoperative 6th-week follow-up, which is favorable to the patient, while SIG witnessed more amount against the rule astigmatism.Conclusion: Frown incision is a better incision than the straight incision in MSICS to create a sclerocorneal tunnel.

Comparison of surgically induced astigmatism in chevron, straight, and frown incisions in manual small-incision cataract surgery.

: The study was conducted to calculate and compare the surgically induced astigmatism (SIA) in chevron, frown, and straight incisions in manual small-incision cataract surgery (MSICS). A prospective, hospital-based study was conducted on 90 patients aged 50 years and above with nuclear sclerosis of grade 4 or more. Each group had 30 patients, divided into Group V (chevron incision), Group S (straight incision), and Group F (frown incision). Patients who had with-the-rule (WTR) astigmatism were operated on through a chevron or straight incision superiorly, while patients who had against-the-rule (ATR) astigmatism underwent MSICS through a temporal frown incision. The patients were followed up post-operatively on days 1, 7, 6 weeks, and 12 weeks, and at each visit, the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and SIA were calculated and compared. The mean age of all the patients was 66.22 ± 8.05 years. BCVA of at least 6/18 or better at 12 weeks post-operatively was achieved in 29 patients (97%) in Group V, 28 patients (93%) in Group F, and 29 patients (97%) in Group S. The mean SIA in Group V was 0.34D ± 0.22D, in Group S was 0.97D ± 0.29D, and in Group F was 0.575D ± 0.25D. SIA by chevron incision is the least followed by the frown incision and straight incision. The superiorly placed chevron incision in WTR astigmatism provided optimal results for the best UCVA and minimal SIA. The temporal frown incision in ATR astigmatism also had good results.

Study of changes in pre-existing against-the-rule astigmatism after temporal manual small-incision cataract surgery using frown, straight, and smile incisions.

To assess the change in the amount of astigmatism caused by frown, straight, and smile incision in patients with pre-existing against-the-rule (ATR) astigmatism of more than and equal to 1 diopter. This is a prospective, comparative study conducted over 18 months on 60 patients. Twenty patients were allocated to each incision using simple random sampling. Demographic details, best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior and posterior segment evaluation, and A-scan were done. An average of three measurements of K horizontal (Khavg), K vertical (Kvavg), and difference between the two (Khavg - Kvavg) were taken using manual keratometry. All surgeries were performed by a single surgeon. All the data analyses were performed by using IBM Statistical Package for the Social Sciences (SPSS) version 20 software. Frequency distribution and cross tabulation were performed to prepare the tables. In frown incision, Khavg - Kvavg was significantly decreased on day 45 from the preoperative value (P &lt; 0.001), followed by straight incision (P &lt; 0.001), and smile incision (P &lt; 0.001). Maximum decrease was observed in frown incision (49.15%) followed by straight (37.75%) and smile (28.57%) incisions. Our results are consistent with reduction of pre-existing ATR astigmatism with temporal incisions, and frown incision seems to be the best approach.

Customized incision cataract surgery: Astigmatism modulation techniques in manual small-incision cataract surgery.

Advanced instrumentation and intraocular lenses (IOL) allow great refractive and visual outcome control to permit excellent correction of refractive aberrations. Residual astigmatism can be modified to provide depth of focus using an appropriate incision in the steepest meridian in manual small-incision cataract surgery (MSICS). The authors describe the nomogram for surgically correcting astigmatism (SCA). This technique can handle preoperative astigmatism of about 2.25 DCyl with the standard incisions-straight incision of 5, 6, and 7 mm in length, the minimally curved frown incision, the frown incision, the frown incision with an accentuated frown, and the U incision placed on the steep axis in the superior or the temporal quadrant depending on the axis of pre-operative astigmatism.

State of the nation survey on cataract surgery in India.

To study the knowledge, attitudes, and practices of the ophthalmologists in India regarding cataract extraction practices. A prospective, online, descriptive study was conducted from January 2022 to April 2022 using a self-developed validated questionnaire attached which was administered through a generated link. The mean age of these 153 respondents was 47.02 (SD = 11.53) years with a male preponderance (70.59%). The majority (52.9%) had completed a fellowship after their post-graduation, and 56.20% provided sub-specialty services. Comprehensive ophthalmology (69.93%) and anterior segment (50.32%) practice were the most popular. Although 76.47% of respondents used a mix of techniques, 11.11% surgeons used only phaco-emulsification and 9.8% used only manual small-incision cataract surgery (MSICS) as the lone cataract treatment modality. Roughly 38% felt that outcomes were comparable for phaco-emulsification and MSICS, whereas about 44% opined that the outcomes of phaco-emulsification were better. MSICS outcomes were reported to be better by approximately 15%. The frown incision (53.59%), the straight incision (19.60%), and the straight incision with back cuts (10.45%) were popular. The majority (71.24%) of the respondents were willing to train fellow ophthalmologists and youngsters in MSICS. Standalone practices and family practices (42.48%), private eye institutes (10.45%), medical colleges (12.41%), and government non-teaching hospitals (11.11%) were the major service providers. 4% were working in rural hinterland. The majority of the surgeons use a mix of cataract extraction operative techniques. A large, willing talent pool of manual small-incision cataract surgeons exists. India can be a global hub for MSICS delivery and training.

Global preferred practice patterns in manual small incision cataract surgery

Objectives: Manual small incision cataract surgery (MSICS) has become the surgery of choice in developing countries and setups with a high cataract load; being non-inferior to phacoemulsification, with minimum dependency on technology, and a shorter learning curve. There exist high variability and multiple differing personal preferences in its instrumentation and techniques. Through our study, we aimed to analyse different MSICS practice patterns across the globe to be able to summarise the commonly performed variations and carve a path for MSICS training programmes and help novice surgeons learn the state-of-the-art methods. Materials and Methods: Ours was an online, questionnaire-based cross-sectional observational study. The Google form was floated among ophthalmologists through social media, globally. The preferences for each step of MSICS from the type of anaesthesia used to post-operative advice were asked and responses analysed. Results: Out of 278 respondents, 234 (84.17%) ophthalmologists used peribulbar anesthesia; 214 (77.3%) preferred to do capsulorrhexis first followed by corneoscleral tunnel incision; 145 (52.15%) preferred frown incision; and 152 (54.7%) considered astigmatism management important during tunnel-making. The majority (226 [81.3%]) surgeons used anterior chamber maintainer. Viscoexpression, wire-Vectis, and irrigating Vectis were practiced by 122 (43.9%), 96 (34.5%), and 64 (23%), respectively. As for the intraocular lenses, 175 (62.9%) surgeons preferred non-foldable and non-premium while 65 (23.4%) used multifocal. Viscoimplantation was preferred by 256 (92.1%) surgeons. Only 13 (4.7%) surgeons sutured the tunnel at the end while a subconjunctival antibiotic-steroid injection was used by 166 (59.7%) surgeons. Conclusion: Studying the variability in MSICS can help to carve future MSICS training programs and help novice surgeons to better perform the surgery.

Comparison of postoperative astigmatism in small incision cataract surgery based on size and shape of the incision

Study of comparison of postoperative astigmatism in small incision cataract surgery depending on size and shape of incision A prospective study of 50 eyes of 50 patients who underwent manual SICS under local anaesthesia between December 2020 and May 2021 conducted by single surgeon and followed up on post op day 1 day 7 and 6 weeks. Patients selected were having grade 1 to 2 nuclear sclerosis the size and shape of incision was decided depending upon the grade of cataract. On follow ups thorough ocular examination was done especially looking for corrected visual acuity and correction needed for that. Keratometry was done in each follow up visits. At the end surgically induced astigmatism (SIA) was calculated. Surgically Induced Astigmatism (SIA) calculated by SIA calculator SIA was 0.5 - 1 D in 38 patients with frown incision of 4 to 5mm,1.0 - 1.5 D in 10 patients with frown incision size of 5 to 6mm 2D in patients with straight incision size of 6mm and more In all cases. The less average SIA was noted in group with smaller incision of about 4 to 5mm. Frown superior incision has got added advantage of early wound stabilization than straight incision. It is possible to reduce the amount of post-operative astigmatism significantly by choosing the incision shape and size.

Refractive Outcomes of Retropupillary Fixated Iris-Claw Lens for Exchange of the Dislocated Intraocular Lens Using Modified Scleral Incisions.

PurposeTo evaluate refractive outcomes after retropupillary iris-claw intraocular lens (IOL) implantation and to compare postoperative astigmatism from (1) a conventional 5.5-mm sclerocorneal incision, (2) an L-shaped scleral tunnel incision, and (3) a frown scleral tunnel incision.MethodsThis was a retrospective study of eyes undergoing dislocated IOL exchange for a retropupillary iris-claw IOL. Uncorrected and corrected distance visual acuity (UDVA and CDVA) and postoperative complications were evaluated until postoperative months 24. The refractive outcomes and the surgically induced astigmatism (SIA) vector were compared between groups.ResultsThe medical records of 107 eyes from 107 patients with mean age of 65.31 ± 12.15 years were reviewed. Eyes with a frown incision showed the best UDVA, followed by those with L-shaped and conventional incisions (P = 0.003). Eyes with an L-shaped incision or frown incision had a lower SIA than that of the conventional incision group at postoperative 6 months (mean ± standard deviation [SD] SIA, 0.86 ± 0.85 D, 0.63 ± 0.37 D, and 1.70 ± 1.27 D for frown incision, L-shaped incision, and conventional incisions, respectively; P = 0.004).ConclusionThe frown incision and L-shaped incision induced a significantly smaller SIA than the conventional incisions, which was associated with better UDVA postoperatively.

Astigmatic Changes in Sutureless Small Incision Cataract Surgery

Introduction: Cataract is the main cause of bilateral blindness in Nepal. Surgery is the accepted treatment option for cataract with Small incision Cataract Surgery (SICS) and Phacoemusification being the common procedures being performed with comparable results. Corneal astigmatism has been a byproduct of cataract surgery since the first limbal incision was made with improved techniques. Self-sealing scleral pocket incisions are stable and provides early healing, faster visual restoration and more importantly superior astigmatism control. A variety of scleral incisions are being used in manual SICS, with the aim of keeping the post-operative astigmatism to a minimum. Despite having many techniques of scleral incision, there have been only few studies which compares surgical induced astigmatism (SIA) between them&#x0D; Objective: To determine surgical induced astigmatism following frown, chevron and straight incision forms in suture-less small incision cataract surgery(SICS).&#x0D; Methodology: A prospective study was done on a total of 120 patients aged 40years and above with senile cataract. The patients were randomly divided into three groups where each group received specific incision- Straight, Frown and Chevron. SICS with intraocular lens (IOL) implantation was performed. The patients were compared on 2 weeks and 6 weeks post operatively for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and keratometric reading. Surgical induced astigmatism (SIA) was calculated using the SIA calculator version 2.0. The study was analysed using SPSS version 20.0.&#x0D; Results: At 6 weeks UCVA of 6/18-6/6 was attained by 63.41%, 78.94% and 84.61% of patients in group straight, frown and chevron. However about 97% of patients attained BCVA of 6/18-6/6 in all three groups. Mean SIA was least in Chevron group (0.30 D ± 0.16) and was most in the straight group (1.22 D ±0.36) which was statistically significant.&#x0D; Conclusion: Chevron incision induces the least astigmatism compared to frown and straight incision.

Surgically induced astigmatism in frown versus chevron incision in MSICS

Cataract surgery remains the foremost cause of reversible blindness globally. Phacoemulsification requires expensive equipment, instruments and higher cost of disposables, along with a longer training curve. Manual small incision cataract surgery (MSICS) has evolved to provide excellent postoperative results, with minimal cost. In developing countries like India, patients present with white/advanced cataract, for which MSICS has proven to provide the best results. MSCIS can be used in any type of cataract, with any type of foldable/rigid intraocular lens implantation. Minimising surgically induced astigmatism is of paramount importance as the patient achieves good uncorrected vision postoperatively, which is the need of the hour. The Chevron incision in MSICS has been reported to provide the best results. We undertook the present study in 100 eyes with white cataract/nuclear sclerosis of grade 4-6 to analyse and compare MSCIS through the Frown incision and Chevron incision. The mean surgically induced astigmatism incision was more in the Frown group (0.82D±0.62) than in the Chevron group (0.55D±0.42), which was statistically significant. (p 0.017). In the Frown versus Chevron group, the best uncorrected visual acuity was 6/12 or better in 62% and 82% respectively. Thus, the Chevron incision was superior to the Frown incision for MSICS, while both yielded good postoperative results. MSICS is the most affordable and effective surgery of choice, especially for white/ hard cataracts.

COMPARISON OF POST OPERATIVE CORNEALASTIGMATISM FOLLOWING FROWN VERSUS CHEVRON INCISION IN MANUAL SMALL INCISION CATARACT SURGERY

Introduction: To study the comparison of post operative corneal astigmatism following frown versus chevron incision in manual small incison in manual small incision cataract surgery. Material and Methods:The study was conducted at govt. medical college jammu over a period of one year. The study includes a total of 100 pts. With age related cataract and were divided into two groups of 50 each. Detailed ocular examination of the cases with calculation of preoperative astigmatism were carried out in eye OPD. Results: st rd th th st All cases were assessed postoperatively at 1 , 3 , 6 and 12 week for surgical induced astigmatism .At the end of 1 week surgical induced astigmatism of more than 1D was seen in 72% pts. of group 1 with frown incision as compared to 48 % in group 2 with chevron incision. At the end of 12 weeks 54% of cases in group 1 with frown incision and only 8% in group 2 with chevron incision had astigmatism of more than 1 D. The difference between the two groups was statistically signicant. Conclusion: It is possible to reduce the amount of postoperative astigmatism signicantly by choosing the incision shape .Surgical induced astigmatism is less seen in patients with chevron incision as compared to patients with frown incision.

Astigmatism in Straight and Frown Incision in Small Incision Cataract Surgery: A Comparative Study

ABSTRACT Introduction Blindness due to cataract presents an enormous problem especially in developing countries like India, not only in terms of human morbidity but also in terms of economic loss and social burden. The cataract surgeon of today is challenged to control the sphere as well as the cylinder of the refraction after surgery. Small incision cataract surgery (SICS) is now the method of choice in many parts of the world. This present study has been carried out with the aim to compare the postoperative corneal astigmatism between the two groups of patients undergoing SICS with posterior chamber intraocular lens (PCIOL) implantation with two difference types of incisions, i.e., frown and straight. Material and methods A prospective study was carried out in 60 patients enrolled from the Department of Ophthalmology of Pondicherry Institute of Medical Sciences who underwent SICS with superiorly placed straight and frown incision with PCIOL (each group consisting of 30 patients) during the period from May 2005 to October 2006. Results In this study, 60 patients having senile cataract in the age group of 50 to 75 years were studied. Out of these, the majority were in the age group of 60 to 64 (28.33%) years and only 26.66% were more than 70 years. The male:female ratio was 1:1. In our study, we found that frown incision had significantly better (p &lt; 0.001) mean net astigmatism as compared with the straight incision. Conclusion We conclude that small incision size and absence of suture are the most important factors that contribute to less astigmatism and faster stabilization of SICS, where phacoemulsification cannot be performed. The duration for stabilization of postoperative astigmatism in straight incision group is 6 weeks, whereas it is 3 weeks in frown incision. Frown superior incision has got added advantage of early wound stabilization than straight incision, allowing the patient to resume their daily activities at an early stage. Superior incision group (both frown and straight) had increased amount of with-the-rule (WTR) astigmatism which later shifted to against-the-rule. There was a significant difference in net astigmatism between frown and straight. Postoperative astigmatism also depends on preoperative astigmatism. Patients with preoperative WTR benefited from superior incision cataract surgery. How to cite this article Tripathi S, Srinivasan M, Gupta S. Astigmatism in Straight and Frown Incision in Small Incision Cataract Surgery: A Comparative Study. Int J Adv Integ Med Sci 2017;2(3):111-116.

Assessment of corneal astigmatism following frown and straight incision forms in sutureless manual small incision cataract surgery.

To investigate which of two tunnel incision forms (frown versus straight) in sutureless manual small incision cataract surgery creates more corneal astigmatism. Sixty eyes of 60 patients who had consented to undergo cataract surgery and to partake in this study were followed from baseline through >12-week postoperative period. Values of preoperative and postoperative corneal astigmatism for the 60 eyes, measured with a Bausch and Lomb keratometer, were extracted from the patients’ cataract surgery records. Residual astigmatism was computed as the difference between preoperative and postoperative keratometry readings. Visual acuity was assessed during the preoperative period and at each postoperative visit with a Snellen chart at 6 m. Fifty eyes of 50 patients were successfully followed-up on. Overall, the mean residual astigmatism was 0.75±0.12 diopters. The differences in mean residual astigmatism between the two different incision groups were statistically significant (t [48]=6.33, P<0.05); frown incision group recorded 1.00±0.12 diopters, whereas the straight incision group recorded 0.50±0.12 diopters. No significant difference was observed between male and female groups (t [48]=0.24, P>0.05). Residual corneal astigmatism in the frown incision group was significantly higher than in the straight incision group. Fisher’s exact test did not reveal a significant association between incision forms and visual acuity during the entire postoperative period (P>0.05).

Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery.

To determine the surgically induced astigmatism (SIA) in Straight, Frown and Inverted V shape (Chevron) incisions in manual small incision cataract surgery (SICS). A prospective cross sectional study was done on a total of 75 patients aged 40y and above with senile cataract. The patients were randomly divided into three groups (25 each). Each group received a particular type of incision (Straight, Frown or Inverted V shape incisions). Manual SICS with intraocular lens (IOL) implantation was performed. The patients were compared 4wk post operatively for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and SIA. All calculations were performed using the SIA calculator version 2.1, a free software program. The study was analyzed using SPSS version 15.0 statistical analysis software. The study found that 89.5% of patients in Straight incision group, 94.2% in Frown incision group and 95.7% in Inverted V group attained BCVA post-operatively in the range of 6/6 to 6/18. Mean SIA was minimum (-0.88±0.61D×90 degrees) with Inverted V incision which was statistically significant. Inverted V (Chevron) incision gives minimal SIA.