1. 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

2. 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.

3. 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

4. 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.

5. 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.

6. Dermographics and preoperative astigmatism Group IGroup IIGroup IIIGroup IVP-value Eye12111214 Age59.36±11.7945.60±16.8655.67±12.3258.57±13.590.319 Gender ( F : M ) 7 : 55 : 68 : 46 : 8 Autorefractor : Cylinder (D) 1.70±1.381.43±0.760.96±0.911.53±1.360.461 Topography : Sim K’s (D) 1.67±0.521.02±0.620.88±0.541.48±0.260.110

7. 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±1.10 1.25±0.68 1.09±0.69 1.20±0.88 1.20±0.86 1.27±1.13 1.40±1.30 1.23±1.09 1.29±1.06 1.33±1.02 0.971 0.016 0.026 0.808 0.061 Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.55±1.15 1.35±0.89 1.52±0.93 1.44±0.90 1.21±0.79 1.53±1.07 1.51±1.08 1.49±1.11 0.466 0.036 0.585 0.446

8. 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).

9. 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±1.17 1.28±1.00 1.00±0.73 1.01±0.77 1.01±0.81 1.46±1.09 1.39±1.15 1.34±1.09 1.49±1.11 1.53±1.30 0.971 0.621 0.051 0.050 0.048 Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.40±1.14 1.34±0.88 1.42±0.95 1.29±0.97 1.30±0.79 1.56±1.11 1.61±1.07 1.65±1.05 0.466 0.537 0.585 0.446

10. 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).

11. Results – Group comparison Group IGroup IIGroup IIIGroup IV Autorefractor Preoperative Postoperative 1 day Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.70±1.38 1.32±0.75 1.23±0.76 1.25±0.83 1.25±0.74 1.43±0.76 1.17±0.59 0.92±0.56 1.14±0.94 1.14±0.98 0.96±0.91 1.25±1.18 0.79±0.65 0.79±0.82 1.53±1.36 1.54±1.38 1.61±1.25 1.71±1.15 1.79±1.41 Topography Preoperative Postoperative 1 week Postoperative 1 month Postoperative 2 months 1.67±0.52 1.50±1.00 1.67±1.08 1.53±1.08 1.02±0.62 1.16±0.69 1.34±0.67 1.32±0.59 0.88±0.54 1.20±0.73 1.18±0.75 1.07±0.78 1.48±0.26 1.81±1.23 1.79±1.23 1.86±1.22

12. Results – Group comparison

13. 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.