Hyun Seung Kim, M.D. Department of Ophthalmology, St. Mary’s hospital, The Catholic University of Korea Changes in Astigmatism After Clear Corneal Temporal.

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Hyun Seung Kim, M.D. Department of Ophthalmology, St. Mary’s hospital, The Catholic University of Korea Changes in Astigmatism After Clear Corneal Temporal Incision Cataract Surgery in With-The-Rule Astigmatism Patient

Introduction Inserting the IOL in the bag Capsule bag diameter < Total IOL length → Angulation between IOL optic and haptic may occur → IOL angulation might induce astigmatism perpendicular to the inserted axis.

Purpose This study is to compare changes of with-the-rule astigmatism after clear corneal temporal incision cataract surgery in with-the-rule astigmatic patients. Suturing temporal incision vs. not suturing IOL haptic insertion at 180° vs. 90° axis

Materials and Methods 47 patients (49 eyes) with grade 3 cataract Operation procedure 3 mm clear corneal temporal incision with a diamond blade Phacoemulsification of the lens nucleus was performed with phacoemulsifier (Infiniti, Alcon, USA). IOL (One-piece AcrySof ®, SA60AT, Alcon Laboratories, Forth Worth, TX, USA ; total length 13.0 mm) was inserted in the bag. After placing the IOL in the bag, IOL rotation was performed to place the haptic axis at 180°or 90°. IOL haptic insertion axis was randomly selected. Incision suture was performed with 10-0 nylon (one radial suture), randomly. It was removed at postoperative 1 month.

Materials and Methods Patients were divided into four groups according to IOL haptic insertion axis and incision suture Group I : IOL haptic axis at 180°+ Incision suture done. Group II : IOL haptic axis at 90°+ Incision suture done. Group III : IOL haptic axis at 180°+ Incision suture not done. Group IV : IOL haptic axis at 90°+ Incision suture not done. Astigmatic changes were compared by Autorefractor (BK-F1, Canon) and Topography (Orbscan II, Orbtek) at preoperative and postoperative 1 day, 1 week, 1 month, 2 months. Pupil dilatation was done at postoperative 1 month and patients with IOL rotation from the original insertion axis were excluded from the study.

Dermographics and preoperative astigmatism Group IGroup IIGroup IIIGroup IVP-value Eye Age59.36± ± ± ± Gender ( F : M ) 7 : 55 : 68 : 46 : 8 Autorefractor : Cylinder (D) 1.70± ± ± ± Topography : Sim K’s (D) 1.67± ± ± ±

Results – Suture vs. No suture Suture Group (Group I+II) No suture Group (Group III+IV) P-value Autorefractor Preoperative Postoperative 1 day Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.54± ± ± ± ± ± ± ± ± ± Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.55± ± ± ± ± ± ± ±

Results – Suture vs. No suture Topography : Corneal astigmatism tends to increase in no suture group, as an relaxing effect of temporal incision. There are no statistical significance between two groups, except at postoperative 1 week (A). Autorefractor : Refractive astigmatism tends to decrease in suture group at postoperative 1 day, 1 week, 1 month and 2 months. Astigmatism showed significant difference between two groups at postoperative 1 day and 1 week, but it showed no difference at postoperative 1 month and 2 months (B).

Results – Haptic 180°vs. Haptic 90° Haptic 180° (Group I+III) Haptic 90° (Group II+IV) P-value Autorefractor Preoperative Postoperative 1 day Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.32± ± ± ± ± ± ± ± ± ± Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.40± ± ± ± ± ± ± ±

Results – Haptic 180°vs. Haptic 90° Topography : There are no statistical difference between two groups (A). Autorefractor : Refractive astigmatism of group with IOL haptic insertion axis at 180˚showed significant difference compared to the group with IOL haptic insertion axis at 90˚at postoperative 1 week, 1 month and 2 months. It was also significantly decreased in group with IOL haptic axis at 180˚compared with preoperative astigmatism at postoperative 1 week, 1 month and 2 months (B).

Results – Group comparison Group IGroup IIGroup IIIGroup IV Autorefractor Preoperative Postoperative 1 day Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.70± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±1.41 Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.67± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±1.22

Results – Group comparison

Conclusions When performing cataract surgery in with-the-rule astigmatism patients Suturing the temporal incision may reduce WTR astigmatism comapred with not suturing the incision. Inserting the IOL haptic axis at 180°may have an effect of reducing WTR astigmatism compared with IOL inserted at 90° axis. Further clinical study is needed. Compare the results with ATR astigmatic patients. Difference between angulation of IOL haptic inserted at 90°or 180°and difference between IOL types.