Temporal Clear Corneal Incision Research Articles

Endophthalmitis After Intraocular Lens Exchange: The Role of Wound Leak

Acute-onset endophthalmitis after intraocular lens (IOL) exchange is a rare clinical entity. The following series describes two patients who presented with endophthalmitis and light perception vision following IOL exchange and were treated with pars plana vitrectomy and intravitreal antibiotics. Wound leak from the temporal clear corneal incision was noted in both patients. Immediate intravitreal antibiotics and pars plana vitrectomy led to a favorable outcome in one of the two patients.

Novel approach for phacoemulsification during combined phacovitrectomy.

PurposeTo evaluate the safety and efficacy of surgeon’s superior sitting position during temporal clear corneal incision (TCCI) phacoemulsification, with a 90° working angle, during combined phacovitrectomy.MethodsProspective interventional case series were performed on 65 eyes of 63 patients. TCCI phacoemulsification was done in all cases (whether right or left eyes), while the surgeon was sitting superiorly to the operating table.Outcome measures includedShift in sitting position, keratometric astigmatism, surgically induced astigmatism, posterior capsule integrity, and intraocular lens centration.ResultsPhacoemulsification was performed completely in all cases (100%). Shift in position to temporal sitting position happened in two cases (3%). The keratometric astigmatism showed mean changes of 1.09 D (0.25–3.75 D) to 0.84 D (0.00–3.25 D) at 1 month, which remained stable at 6 months; 0.84 D (0.16–3.21 D). The surgically induced astigmatism was 0.25 DC (−0.50 to 1.0 DC) at 1 month, which stayed stable at 6 months; 0.25 D (−0.63 D to 0.98 D). Posterior capsular rupture occurred in one case (the second case) (1.5%). The intraocular lens was centered in all cases (100%).ConclusionSuperior sitting TCCI phacoemulsification, with a wide working angle, during combined phacovitrectomy proved safe and easy, without the burden of changing and disrupting the operative setting. The anatomical and optical outcomes were acceptable.

The pattern of early corneal endothelial cell recovery following cataract surgery: cellular migration or enlargement?

To evaluate whether cellular migration or enlargement is the main mechanism of initial endothelial cell recovery following cataract surgery. A prospective observational study, of 24 patients aged 50-80years who were diagnosed with moderate cataract and received uncomplicated cataract surgery with a 2.75mm temporal clear corneal incision, was performed in Seoul National University Bundang Hospital. Endothelial cell density (ECD) and area (ECA) were obtained in central and four paracentral (superior, inferior, nasal, and temporal) areas using non-contact specular microscopy. ECD, ECA, ECD% (ECD% = ECD in each area/the sum total of ECD in five areas), and the coefficient of variation of ECA (CV) in each location were investigated pre- and 1day, 1week, and 4weeks postoperatively. ECD significantly decreased 1day, 1week, and 4weeks postoperatively (p = 0.010, 0.015, and 0.003 respectively), and ECA increased (p = 0.008, 0.013, and 0.002 respectively) in only the temporal area. Postoperative ECD% decreased, and CV increased in only the temporal area significantly, when compared to preoperative values. There were no significant postoperative changes of ECD, ECA, ECD%, and CV in other areas. Postoperative changes of ECD, ECA, ECD%, and CV were limited to the temporal area adjacent to the primary corneal incision. Cellular enlargement, rather than migration, may have the major effect on early endothelial cell recovery after cataract surgery.

Comparison of endothelial cell loss by specular microscopy between phacoemulsification and manual small-incision cataract surgery

Aim: To compare the endothelial cell loss between phacoemulsification and manual small-incision cataract surgery (SICS). Endothelial cell loss was also compared in phacoemulsification group by temporal clear corneal incision (CCI) and by superior scleral incision (SI) technique. Materials and Methods: A total of 200 eyes of 200 patients were included in the study. Cases were randomly divided into two equal groups. Group A had undergone phacoemulsification and Group B had under gone manual SICS. In Group A 50 cases were performed by temporal CCI and remaining 50 cases were performed by superior SI technique. Endothelial cell count was evaluated by using a noncontact specular microscope. Results: Mean endothelial cell loss (cells/mm 2 ) in Group A was 307.80 (12.33%), 397.79 (15.93%), and 421.69 (16.89%) on 1 week, 6 week, and 3 month postoperative period, respectively. In Group B, it was 270.86 (10.63%), 385.22 (15.12%), and 413.68 (16.24%) on 1 week, 6 week, and 3 month postoperative period, respectively. There was no clinical and statistically significant difference (P > 0.05) between the two groups. The mean endothelial cell loss in Group A by CCI was 340.68 (13.61%), 427.80 (17.08%), and 448.70 (17.92%) and by SI was 274.92 (11.05%), 367.78 (14.78%), and 394.68 (15.83%) on 1 week, 6 week, and 3 month postoperative period respectively. There was statistically significant difference in endothelial cell loss at 1 week (P 0.05). Conclusion: There was no clinically or statistically significant difference in endothelial cell loss or visual acuity between phacoemulsification and manual SICS at 3 month postoperative period.

Fourier-domain optical coherence tomography evaluation of clear corneal incision structure according to blade material

To use Fourier-domain optical coherence tomography (OCT) to evaluate the wound characteristics of clear corneal incisions (CCIs) created with a metal or diamond blade in cataract surgery. Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea. Prospective comparative observational study. Patients who had cataract surgery were randomized into 2 groups based on whether a metal blade (Group 1, 37 eyes) or diamond blade (Group 2, 33 eyes) was used to create a 2.8 mm temporal CCI. One day, 1 week, and 1 month postoperatively, structural characteristics of the CCI were analyzed using RTVue-100 Fourier-domain OCT. Parameters included incision angle, corneal thickness, epithelial or endothelial gaps, and Descemet membrane detachment. Visual acuity, surgically induced astigmatism (SIA), and ocular aberrations were evaluated. There was a significant difference in corneal thickness at the 1.0 mm temporal side from midpoint. The mean uncorrected distance visual acuity in Group 2 (33 eyes) improved significantly over time. In both groups, corneal thickness at the midpoint, 1.0 mm temporal side, and 1.0 mm nasal side from the midpoint of the incision significantly decreased over time. At all timepoints, temporal and nasal thickness in Group 2 was significantly greater than in Group 1 (37 eyes), with the exception of temporal thickness at 1 month. In both groups, wound healing was reliable over time. There were no significant between-group differences in SIA or changes in aberrations. Corneal thickness at the incision site showed a significant difference between the 2 groups. Both groups achieved structural stabilization. No author has a financial or proprietary interest in any material or method mentioned.

Astigmatism Correction in Cataract Surgery with Foldable Toric IOL

<p><strong>Aim:</strong> To evaluate correction of pre-existing astigmatism after foldable Toric IOL implantation in patients undergoing cataract surgery.</p><p><strong>Materal & Methods:</strong> In this prospective observational study we included 10 eyes of 10 patients with astigmatism between 2.00D to 6.00D &undergoing cataract surgery. Phacoemulsification was performed with Toric IOL implantation through 2.8mm clear corneal temporal incision. Patients were examined post operatively for Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA) & residual refractive astigmatism.</p><p><strong>Statistical Analysis:</strong> Statistical analysis was performed by the SPSS program for Windows, ver.16.0.Continuous variables are expressed as mean ± SD, and categorical variables are presented as absolute numbers and percentage. For the statistical test, a p value less than 0.05 was taken to indicate a significant difference.</p><p><strong>Results:</strong> The UCVA was 6/9 or better in 90% of eyes. 80% eyes achieved 6/6 BCVA. The mean refractive cylinder corrected from -3.4 ± 1.4 D to -0.60 ± 0.27 D which was statistically significant. (p value=0.0001).</p><p><strong>Conclusion:</strong> Toric IOL implantation is an effective, safe surgical option to manage pre-existing corneal astigmatism during cataract surgery.</p>

Astigmatism Correction in Cataract Surgery with Foldable Toric IOL

Aim: To evaluate correction of pre-existing astigmatism after foldable Toric IOL implantation in patients undergoing cataract surgery. Materal & Methods: In this prospective observational study we included 10 eyes of 10 patients with astigmatism between 2.00D to 6.00D &undergoing cataract surgery. Phacoemulsification was performed with Toric IOL implantation through 2.8mm clear corneal temporal incision. Patients were examined post operatively for Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA) & residual refractive astigmatism. Statistical Analysis: Statistical analysis was performed by the SPSS program for Windows, ver.16.0.Continuous variables are expressed as mean ± SD, and categorical variables are presented as absolute numbers and percentage. For the statistical test, a p value less than 0.05 was taken to indicate a significant difference. Results: The UCVA was 6/9 or better in 90% of eyes. 80% eyes achieved 6/6 BCVA. The mean refractive cylinder corrected from -3.4 ± 1.4 D to -0.60 ± 0.27 D which was statistically significant. (p value=0.0001). Conclusion: Toric IOL implantation is an effective, safe surgical option to manage pre-existing corneal astigmatism during cataract surgery.

English

PURPOSE: To evaluate and compare the surgical induced astigmatism in Phacoemulsification done by 2.80 and 5.30 mm clear corneal incision and SICS done through superiorly placed 6.00mm scleral incision. METHODS: Group - 1:2.80 mm clear corneal, sutureless, temporally placed incision with phacoemulsification technique (PE); Group-2:5.30 mm clear corneal, sutureless, temporally placed incision with phacoemulsification technique (PE); Group-3: 6 mm, straight scleral, sutureless, superiorly placed incision with manual small Incision cataract surgery (MSICS). RESULTS: Keratometric Cylinder (KC): The KC at 1 day, 1 week, 1 month, 3 month, was 1.26±0.54, 1.03±0.44, 0.99±0.36, 0.92±0.36 in group - 1; 1.90±0.41, 1.53±0.29, 1.37±0.28, 1.37±0.28 in group - 2 and 1.62±0.56, 1.43±0.68, 1.23±0.56, 1.21±0.49 in group 3 respectively.; Surgical Induced Astigmatism (SIA): The SIA at 1 week, 1 month, 3 month, was 0.64 ± 0.32, 0.55 ± 0.31, 0.48 ± 0.32 in group - 1; 1.00 ± 0.40, 0.84 ± 0.39, 0.84 ± 0.39 in group - 2 and 1.49 ± 0.77, 1.39 ± 0.46, 1.37 ± 0.40 in group - 3 respectively. After analysis, statistically significant (P<0.05) difference noted in keratometric cylinder & SIA between Group - 1 v/s Group - 2, Group - 1 v/s Group - 3 and Group - 2 v/s Group - 3 from day 1 & subsequent follow up. The preoperative parameters i.e. UCVA, mean keratometry & keratometric cylinder between the three groups were comparable. There was no statistically significant difference found between three groups preoperatively. CONCLUSION: Phacoemulsification 2.80 mm clear corneal temporal incision cataract surgery induces least SIA postoperatively, 5.30 mm incision induces 2nd least SIA & 6.00 mm straight superior scleral manual SICS induces the maximum SIA among the 3 groups.

English

Surgically induced astigmatism (SIA) is a common obstacle for achieving excellent uncorrected visual acuity after Phacoemulsification with implantation of foldable IOL. The aim of the study was to determine the magnitude of surgically induced post-operative astigmatism after phacoemulsification with intraocular lens implantation through a temporal clear corneal incision. This study included 16 eyes with senile cataract which were operated using phacoemulsification with implantation of a foldable intraocular lens through a temporal clear corneal incision. Temporal incision at 180 degree was used for all cases. Astigmatism was measured by autorefracto keratometer preoperatively and at 6 weeks postoperatively. The mean surgically induced astigmatism was 0.53 D (Diopter) with the Rule. The vertical component of astigmatism increased postoperatively than preoperatively. Horizontal component of astigmatism decreased in majority of cases postoperatively.

Central Retinal Arterial Occlusion (CRAO) after Phacoemulsification-A Rare Complication

While peribulbar anesthesia is generally safe, a remote risk of retinal vascular accident exists and its routine use should be done with caution. To report a case of central retinal artery occlusion (CRAO) that occurred within 24 hours of routine uneventful phacoemulsification cataract surgery using peribulbar anesthesia. We share our experience of a 45-year old man who underwent uneventful clear corneal temporal incision phacoemulsification cataract surgery using peribulbar lignocain injection with adrenaline. A Patient who underwent routine phacoemulsification surgery of left eye for posterior sub-capsular cataract under peribulbar anesthesia developed central retinal artery occlusion in the immediate post-operative period. The surgery was uneventful. Central retinal artery occlusion is a rare but dreadful complication seen after uneventful phacoemulsification and the cause is mainly due to anesthesia related.

Comparison of different corneal incisions on corneal refraction after phacoemulsification and foldable intraocular lens implantation

Objective To compare the effect of different corneal incisions on corneal refraction after phacoemulsification and foldable intraocular lens implantation.Methods 42 eyes of 35 patients with cataract were divided into two groups randomly:group A,received temporal clear corneal incision(18 eyes of 18 cases),group B,received superior(11:00) clear corneal incision (24 eyes of 17 cases).Patients were examined preoperatively and 1 day,1 week,1 month and 3 months postoperatively by using slit-lamp microscope and corneal topography,and visual acuity also was examined.Results The visual acuity in group A was better than that in group B at 1 day postoperatively.But at 1 week,1 month,2 months postoperatively,the difference of visual acuity between two groups was not statistically significant.At 1 day preoperatively and at 1 day,1 week,1 month,2 months postoperatively,the mean astigmatism were (0.543 ± 0.264) D,(0.821 ±0.317)D,(0.732±0.320)D,(0.690±0.283)D,(0.657 ±0.233)D and (0.51 ±0.27)D in group A respectively.And at the same time points,the mean astigmatism in group B were (0.568 ± 0.243)D,(1.092 ± 0.357) D,(0.987 ± 0.257) D,(0.934 ± 0.312) D and (0.866 ± 0.371) D respectively.The mean astigmatism in group A was lower than in group B,and the difference was statistically significant (P ＜0.05).The superior incision group showed against-the-rule astigmatic changes,whereas with-the-rule astigmatism was seen in the temporal incision group.Conclusion The visual acuity in the temporal incision group was better than that in superior incision group at 1 day postoperatively.And the mean astigmatism changes in group A was lower than in group B. Key words: Phacoemulsification, cataract; Incision, corneal; Refraction, corneal

Evaluation and comparison of surgically induced astigmatism between phacoemulsification and small incision cataract surgery

Background: Surgically induced astigmatism is the cause of poor postoperative vision even after uneventful cataract surgery. Aim: The aim of study was to compare the incidence, amount, type, and course of surgically induced astigmatism and visual acuity in temporal 5.5-mm clear corneal phacoemulsification and 6-mm superior scleral incision in Small incision cataract surgery (SICS). Materials and Methods: A total of 200 eyes of 200 patients with a mean age of 62 years were included in the study. Cases were randomly divided into two groups. Group A had undergone 5.5-mm temporal clear corneal phacoemulsification and group B had undergone 6-mm superior scleral SICS. Surgically induced astigmatism was analyzed by SIA software. Results: Mean age in group A was 61 (±8) years and in group B was 63 (±10) years. Mean surgically induced astigmatism in group A was 1.05 (±0.58) D, 1.13 (±0.52) D, 1.13 (±0.56) D, and 1.08 (±0.52) D on 1 st , 7 th , 21 st , and 45 th postoperative days, respectively. The change from 1 st to 45 th day was not significant. The same in group B was 0.75 (±0.58) D, 0.81 (±0.54) D, 0.88 (±0.49) D, and 0.91 (±0.47) D on 1 st , 7 th , 21 st , and 45 th postoperative days, respectively. Surgically induced astigmatism was comparable on all days between the groups. We found significant with the rule and against the rule type of astigmatism post-operatively in the temporal clear corneal incision in phacoemulsification group and in superior scleral incision in small incision cataract surgery group respectively. Conclusion: Surgically induced astigmatism was higher in the 5.5-mm temporal clear corneal group than in the superior scleral group. Clinical outcome of both surgeries was same, as there was no significant difference in the uncorrected postoperative visual acuity in between the groups.

Secondary toric intraocular lens implantation for post-operative ammetropia and astigmatism after small incision cataract surgery

We report a case of 56-year-old female who had undergone left eye small incision cataract surgery 2 months earlier with history of no visual gain uncorrected after surgery. On examination, she had a superior scleral tunnel incision with 6.5 mm optic poly methyl metha acrylate (PMMA) posterior chamber intraocular lens (IOL) in the bag. Her manifest refraction was -5.0 diopter sphere and -3.0 diopter cylinder (DC) at 180°. Her visual acuity improved from 20/200 to 20/20 after correction. The patient underwent explanation of the PMMA IOL with implantation of 23.5 D Acriol EC-T4 toric IOL through temporal clear corneal incision. Postoperatively, at 6 months, the patient had 20/20 (p) visual acuity uncorrected improving to 20/20 after correction by -0.25DC at 40°. Postoperative ammetropia and high cylindrical power can be simultaneously corrected by placement of the toric IOL.

Surgically induced astigmatism after 3.0 mm temporal and nasal clear corneal incisions in bilateral cataract surgery

Aims:To compare the corneal refractive changes induced after 3.0 mm temporal and nasal corneal incisions in bilateral cataract surgery.Materials and Methods:This prospective study comprised a consecutive case series of 60 eyes from 30 patients with bilateral phacoemulsification that were implanted with a 6.0 mm foldable intraocular lens through a 3.0 mm horizontal clear corneal incision (temporal in the right eyes, nasal in the left eyes). The outcome measures were surgically induced astigmatism (SIA) and uncorrected visual acuity (UCVA) 1 and 3 months, post-operatively.Results:At 1 month, the mean SIA was 0.81 diopter (D) for the temporal incisions and 0.92 D for nasal incisions (P = 0.139). At 3 months, the mean SIA were 0.53 D for temporal incisions and 0.62 D for nasal incisions (P = 0.309). The UCVA was similar in the 2 incision groups before surgery, and at 1 and 3 months post-operatively.Conclusion:After bilateral cataract surgery using 3.0 mm temporal and nasal horizontal corneal incisions, the induced corneal astigmatic change was similar in both incision groups. Especially in Asian eyes, both temporal and nasal incisions (3.0 mm or less) would be favorable for astigmatism-neutral cataract surgery.

Correction of Postkeratoplasty Ametropia in Keratoconus Patients Using a Toric Implantable Collamer Lens

To evaluate the efficacy and safety of a toric implantable Collamer lens (Visian TICL®) for correction of high postkeratoplasty ametropia in patients with keratoconus. Seven eyes of 7 keratoconus patients postkeratoplasty (5 M, 2 F; mean age 34.1±5.9 years, range 28-44) unable to wear glasses or contact lenses were included in the study. A foldable phakic posterior chamber Collamer toric lens was injected through a standard 3.0-mm clear corneal temporal incision. Uncorrected distance visual acuity (UCDVA, logMAR), best-corrected distance visual acuity (BCDVA, logMAR), spherical refraction, cylindrical refraction, and refractive spherical equivalent (RSE) were measured preoperatively and postoperatively. Postoperative adverse events were recorded. . The mean follow-up was 12.8±8.8 months (range 4-30). A significant (p<0.01) improvement was observed postoperatively in mean UCDVA (1.18±0.4 vs 0.2±0.1), spherical refraction (-5.89±3.43 vs 0.53±0.75), cylindrical refraction (-4.39±0.75 vs -1.74±0.84), and RSE (-8.09±3.77 vs -0.33±0.54). The BCDVA changes were not significant (0.09±0.11 vs 0.05±0.08). All patients gained ≥5 lines of UCDVA (average 7.6±1.9 lines). The number of patients with UCDVA ≥6/12 (0.3 logMAR) increased after surgery (0% vs 87.5%; p<0.01), while the number of patients with BCDVA ≥6/12 was unchanged (100% vs 100%; NS), with 0% (0/7) of patients losing ≥2 BCDVA lines. No complications were observed postoperatively. Toric implantable Collamer lens was safe and effective in correcting postkeratoplasty myopia and astigmatism in keratoconus patients.

Fluctuations in corneal curvature limit predictability of intraocular lens power calculations

To analyze fluctuations in corneal curvature over time. Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Case series. A 3-piece IOL was implanted in 1 eye and a 1-piece IOL in the other eye through a 3.2 mm clear corneal temporal incision. Keratometry was performed preoperatively and at several points in time postoperatively. Differences between measurements were analyzed by power vectors. Statistical significance was assessed by monovariate, bivariate, and trivariate paired t tests. Acute angle shifts were determined as differences between meridians at 2 points in time. Fifty patients were enrolled. From preoperatively to 1 year postoperatively, the changes in vector components (M, J0, J45) were, respectively, -0.02 diopter (D) ± 0.23 (SD) (P=.38), -0.07 ± 0.27 D (P=.02), and +0.04 ± 0.25 D (P=.14). Corresponding changes from 1 year to 2 years postoperatively were +0.01 ± 0.25 D (P=.73), +0.01 ± 0.23 D (P=.83), and +0.01 ± 0.16 D (P=.40). The meridian shift was -5 ± 32 degrees (P=.13) from preoperatively to postoperatively and +3 ± 22 degrees (P=.23) from 1 year to 2 years. Surgically induced astigmatism was composed of slight flattening in the horizontal meridian and slight steepening in the oblique meridian but was insignificant in relation to random fluctuations, which were almost equally large between postoperative measurements 1 year apart. The fluctuations were not due to imprecision in measurement. Dr. Norrby is a retiree from Abbott Medical Optics, Inc., and holder of a small amount of stock. Dr. Findl is scientific advisor to Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Posterior chamber phakic intraocular lens implantation for correcting high myopia

Objective To evaluate the efficacy and safety of implanting a posterior chamber phakic intraocular lens to correct high myopia. Methods There were 117 eyes of 63 patients with high myopia. The range of preoperative myopia diopters was -5.25 - - 19.0D. The best corrected vision was ≥0.8 in 101 eyes and 0.5 - 0.6 in 15 eyes, and 〈 0.3 in one eye, The examine included uncorrected visual acuity （UC- VA） , corrected visual acuity, corneal endothelium, UBM,intraocular pressure, refraction, tonometry, kerame- ter, pachometer, axial length, depth of anterior chamber, horizontal corneal diameter （ white to white ）, and posterior mean evaluation after indirect ophthalmoscope examination. The posterior chamber phakic intraocu- lar lens manufactured with STAAR collamer was implanted though 3.0 mm sutureless temporal clear corneal incision under topical anesthesia. YAG laser peripheral iridectomy was performed before surgery to avoid pu- pil block glaucoma. The follow-up examination included visual acuity, refrection, tonometer, cornea, and space between crystal lens and IOL. Results 117 eyes implanting were successful , all eyes had a signifi- cant increase in uncorrected visual acuity, and a same or better corrected visual acuity, All eyes maintained a low negative power of refraction, but the patients managed most activities without spectacles. 2 case （ 2 eyes） were found cataract genesis under anterior capsular membrane. Conclusion The posterior chamber phakic IOL was predictable, safe, and efficacious in the correction of high myopic. Key words: High myopia ; Surgery ; Lens, artifical; Phakic eye

Predicting Postoperative Astigmatism Using Scheimpflug Keratometry (Pentacam) and Automated Keratometry (IOLMaster)

Purpose: To compare keratometry measurements obtained using an automated keratometer (AK, IOLMaster) and a Scheimpflug keratometer (Pentacam) in predicting residual astigmatism after cataract surgery.Methods: Preoperative corneal astigmatism was calculated using preoperative refraction, an AK and a Scheimpflug keratometer (anterior corneal power [ACP] and true net power [TNP]) in 155 eyes of 107 Asian subjects. Phacoemulsification cataract removal and nontoric intraocular lens insertion (Akreos®MI-60™, Bausch & Lomb, Rochester, NY, USA) were performed through a 2.8 mm temporal clear corneal incision. Six months later, postoperative astigmatism (postA) was calculated using manifest refraction. Error angle (EA) and error magnitude (EM) of above keratometries (AK, ACP, and TNP) in prediction of postA was calculated. The correlation between preoperative astigmatism and postA was analyzed using power vectors (J0 and J45).Results: AK resulted in the lowest EM and ACP resulted in the lowest EA. Preoperative astigmatism (preA) measured using AK, ACP, and TNP showed significant correlation with postA in both J0 and J45 components. (AK: rJ0 = 0.554, rJ45 = 0.559, ACP: rJ0 = 0.346, rJ45 = 0.281, TNP: rJ0 = 0.409, rJ45 = 0.231). Preoperative refractive astigmatism showed no significant correlation in any components.Conclusions: PreA determined using AK showed superior performance in prediction of postA than ACP and TNP.

Marginally controlled open angle glaucoma and cataract: sequential (1st phacoemulsification,2nd trabeculectomy) versus combined (phacotrabeculectomy) surgery

AbstractPurpose glaucoma patients with borderline controlled intraocular pressure (IOP) may benefit from cataract surgery alone. However it is possible that these patients may need glaucoma surgery at some point in the future. Furthermore the risk of postoperative IOP spikes and the inconvenience of two operations (sequential) should be weighed against the complexity of the combined operation. The purpose of the study is to compare the results of phacotrabeculectomy with trabeculectomy in clear corneal incision pseudophacic eyes.Methods retrospective study of 31 patients with visually significant cataract and open angle glaucoma with IOP 22‐25 mmHg on topical medications. The patients were assigned to either surgical treatment according to their glaucoma severity. 20 patients underwent combined phacotrabeculectomy (two‐sites) and 11 patients underwent sequential (1st phacoemulsification(temporal clear corneal incision with intraocular lens implantation), 2nd trabeculectomy). Antimetabolites and adjustable sutures were used in all glaucoma operations. IOP measurements were recorded. Follow up time was 6‐18 months (median 12 months).Results the effect of type of surgical treatment on postoperative IOPs was not statistically significant. Combined phacotrabeculectomy resulted in higher IOPs by 0.97(95% Confidence Interval [‐1.6 3.59]) mmHg (p=0.47) versus sequential surgery.Conclusion in patients with clinically significant cataract and glaucoma with borderline control of IOP the choice of combined (phacotrabeculectomy) versus sequential (1st phaco, 2nd trabeculectomy) surgery can be done according to the severity of glaucoma and based on surgeon’s preference and experience.

The influence of corneal wound size on surgically induced corneal astigmatism after phacoemulsification

To determine whether there is a difference in surgically induced astigmatism (SIA) after phacoemulsification for unsutured temporal clear corneal incisions of 2.5mm and 3.5mm wound sizes. This study comprised 36 eyes of 18 patients who received cataract surgery from a single surgeon. Patients were randomly assigned to receive a one-piece intraocular lens (IOL; Acrysof SA60AT), through a 2.5mm incision in one eye, and a three-piece IOL (Tecnis Z9000), through a 3.5mm incision in the contralateral eye. Corneal topography was performed preoperatively and also postoperatively at 3, 6, and 12 weeks. SIA was calculated by means of vector analysis using the Alpins' method. The mean SIAs of the groups with 2.5mm and 3.5mm incisions were 0.57 diopter (D) and 0.86 D respectively (p=0.04) at 3 weeks postoperatively, 0.60 D and 0.83 D respectively (p>0.05) at 6 weeks postoperatively, and 0.58 D and 0.58 D respectively (p>0.05) at 12 weeks postoperatively. At 12 weeks postoperatively, SIAs of <1.0 D were found in all eyes in the 2.5mm group and 93% of eyes in the 3.5mm group. Forty-four percent of eyes in both groups demonstrated SIAs>0.5 D at 12 weeks postoperatively. The largest SIA was 1.36 D in the 3.5mm group. Mean SIA in the 3.5mm group was larger than that in the 2.5mm group in the early postoperative period, but there was no significant difference for the entire observational period.