Induced Astigmatism and High-Order Aberrations after 1.8-mm, 2.2-mm and 3.0-mm Coaxial Phacoemulsification Incisions

Sang Jeong Moon; Dong Jun Lee; Kyung Hun Lee

doi:10.3341/JKOS.2011.52.4.407

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Moon, Lee, and Lee: Induced Astigmatism and High-Order Aberrations after 1.8-mm, 2.2-mm and 3.0-mm Coaxial Phacoemulsification Incisions

Original Article

J Korean Ophthalmol Soc 2011;52(4):407-413.

Published online: 6 September 2011

DOI: https://doi.org/10.3341/JKOS.2011.52.4.407

Induced Astigmatism and High-Order Aberrations after 1.8-mm, 2.2-mm and 3.0-mm Coaxial Phacoemulsification Incisions

Sang Jeong Moon, M.D., Dong Jun Lee, M.D., Kyung Hun Lee, M.D.

Sungmo Eye Hospital, Busan, Korea

Address reprint requests to Kyung Hun Lee, MD Sungmo Eye Hospital #1078-7 Woo 2-dong Haeundae-gu, Busan, Korea Tel: 82-51-743-0775, Fax: 82-51-743-0776, E-mail: sungmo@sungmo.co.kr

Received 4 February 20109 November 2010 Accepted 15 February 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To study theeffect of micro incision (1.8 mm) and small incision (2.2 mm and 2.8 mm) coaxial phacoemulsification on surgically induced astigmatism (SIA) and high-order aberrations (HOA) of anterior and posterior corneal surface.

Methods

The present randomized clinical study included 32 eyes having a 1.8-mm, 38 eyes having a 2.2-mm, and 30 eyes having a 2.8-mm corneal incision. SIAs were measured at 1 and 3 months postoperatively. HOAs included coma, trefoil, and spherical aberration. The coma– root mean square (RMS) and trefoil-RMS were evaluated at 1 month after the cataract operation.

Results

Surgically induced astigmatisms were 0.41 ± 0.30 diopter (D) in the 1.8-mm incision group, 0.47 ± 0.21 D in 2.2-mm group and 0.71 ± 0.50 D in the 2.8-mm group. The SIA of the 1.8-mm group was smaller than the other groups (p = 0.002). There was no statistically significant difference in coma, spherical aberration of the corneal anterior surface and trefoil, or spherical aberration of the posterior surface among the 3 groups at 1 month after surgery.

Conclusions

Incision size contributes to postoperative corneal astigmatism. Phacoemulsification cataract surgery with less than 2.8-mm incision does not significantly influence the corneal aberrationsof anterior and posterior corneal surfaces.

Keywords: Coaxial microincisional cataract surgery, High-order aberration, Surgically induced astigmatism

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Figure 1.

Inter-group comparison of surgically induced astigmatism (SIA) at 1 and 3 months after cataract surgery. SIA is statistically different among 1.8-mm, 2.2-mm and 2.8-mm incision group at 1 and 3 months respectively.

Figure 2.

Mean changes (μ m) in high order aberrations and root mean square of anterior corneal surface betweenbaseline and 1 month after operation. Only Z (3, -3) is different in statistical comparison among 3 groups. ^*p<0.05; ^† root mean square.

Figure 3.

Mean changes (μ m) in high order aberrations and root mean square of posterior corneal surface betweenbaseline and 1 month after operation. Only Z (3, -1) is different in statistical comparison among 3 groups. ^*p<0.05; ^† root mean square.

Table 1.

Demographics of patients and surgical results after cataract surgery

Dermographics of patients
Baseline variables	1.8 mm	2.2 mm	2.8 mm	p-value
No. eyes	32	38	30
Age (mean±SD, yr)	64.5 ± 10.5	61.8 ± 15.3	69.4 ± 10.0	0.045^*
UCVA^† (mean±SD, logMAR)	0.71 ± 0.36	0.70 ± 0.33	0.53 ± 0.21	0.053
BCVA^‡ (mean±SD, logMAR)	0.40 ± 0.33	0.45 ± 0.37	0.41 ± 0.21	0.836
SE^§ (mean±SD, diopter)	-1.71 ± 5.98	0.31 ± 1.85	0.02 ± 2.09	0.119
Endothelial cell density (mean±SD, cell/mm²)	2850 ± 419	2618 ± 433	2724 ± 345	0.063
Surgical results after cataract surgery
UCVA (mean±SD, logMAR)	0.34 ± 0.32	0.26 ± 0.30	0.15 ± 0.20	0.029^*
BCVA (mean±SD, logMAR)	0.05 ± 0.09	0.05 ± 0.90	0.06 ± 0.10	0.881
SE (mean±SD, diopter)	-1.05 ± 1.05	-0.45 ± 0.78	-0.32 ± 0.51	0.000^*
Endothelial cell density (mean±SD, cell/mm²)	2516 ± 466	2303 ± 381	2339 ± 329	0.221

^* p-value<0.05;

^† uncorrected visual acuity;

^‡ best corrected visual acuity;

^§ spherical equivalent.

Table 2.

Summary of data of keratometric astigmatisms and corneal meridian

	Astigmatism	1.8 mm	2.2 mm	2.8 mm	p-value
Preop	Astigmatism^* (mean±SD, diopter)	0.72 ± 0.38	0.70 ± 0.38	0.76 ± 0.53	0.846
Preop	Steep axis	87 ± 52	106 ± 51	90 ± 43	0.236
1 month	Astigmatism^* (mean±SD, diopter)	0.78 ± 0.53	0.59 ± 0.44	0.90 ± 0.55	0.520
1 month	Steep axis	99 ± 49	108 ± 37	91 ± 40	0.249
3 months	Astigmatism^* (mean±SD, diopter)	0.76 ± 0.50	0.71 ± 0.48	0.97 ± 0.61	0.122^†
3 months	Steep axis	90 ± 45	109 ± 37	111 ± 26	0.045^†

^* Corneal astigmatism;

^† p-value<0.05.

Table 3.

Comparison of high-order aberrations and root mean square of anterior corneal surface between preoperation and 1 month of cataract surgery within group respectively

Groups	1.8 mmm (mean±SD)			2.2 mm (mean±SD)			2.8 mm (mean±SD)
Zernike terms	preop	postop	p-value	preop	postop	p-value	preop	postop	p-value
Z (3, -3) trefoil	0.032±0.314	0.037±0.219	0.852	-0.079±0.425	0.540±0.860	0.026^‡	0.574±0.318	-0.043±0.259	0.165
Z (3, -1) coma	-0.207±0.296	-0.163±0.222	0.795	-0.178±0.247	-0.213±0.171	0.653	-0.107±0.245	0.070±0.294	0.828
Z (3, 1) coma	0.039 ± 0.349	-0.029±0.261	0.999	-0.176±0.394	0.131±0.338	0.819	-0.009±0.333	0.070±0.294	0.217
Z (3, 3) trefoil	0.167 ± 0.365	-0.009±0.078	0.091	0.078±0.416	0.015±0.311	0.598	0.044±0.220	0.067±0.315	0.814
Z (4, 0) SA^*	0.704±0.204	0.667±0.247	0.113	0.654±0.212	0.652±0.167	0.978	0.689±0.294	0.818±0.264	0.098
Trefoil RMS^†	0.344±0.373	0.412±0.280	0.200	0.369±0.474	0.511±0.779	0.336	0.296±0.251	0.288±0.293	0.910
Coma RMS^†	0.412±0.280	0.316±0.210	0.479	0.457±0.253	0.318±0.238	0.113	0.362±0.217	0.349±0.265	0.782

^* Spherical aberration;

^† root mean square;

^‡ p-value<0.05.

Table 4.

Comparison of high-order aberrations and root mean square of posterior corneal surface between baseline and 1 month after phacoemulsification

Groups	1.8 mm (mean±SD)			2.2 mm (mean±SD)			2.8 mm (mean±SD)
Zernike terms	preop	postop	p-value	preop	postop	p-value	preop	postop	p-value
Z (3, -3) trefoil	0.013±0.448	0.133±0.550	0.677	0.408±0.832	0.592±0.741	0.457	0.160±0.768	0.257±0.687	0.523
Z (3, -1) coma	-0.166±0.636	-0.128±1.074	0.796	-0.109±0.535	-0.558±0.762	0.016^‡	-0.056±0.099	0.226±1.108	0.033^‡
Z (3, 1) coma	-0.449±0.623	-0.460±0.621	0.884	-0.287±0.547	-0.155±0.802	0.513	-0.457±0.621	-0.353±0.570	0.397
Z (3, 3) trefoil	0.510±0.895	0.261±0.360	0.321	0.597±0.908	0.307±0.405	0.234	0.254±0.071	0.270±0.520	0.920
Z (4, 0) SA^*	0.950±0.389	1.051±0.345	0.076	0.796±0.485	0.983±0.423	0.137	0.794±0.497	0.971±0.409	0.026^‡
Trefoil RMS^†	0.790±0.772	0.514±0.418	0.308	0.919±1.039	0.736±0.357	0.598	0.824±0.964	0.705±0.608	0.491
Coma RMS^†	0.861±0.491	1.01±0.578	0.364	0.737±0.321	0.912±0.596	0.710	0.160±0.768	0.257±0.687	0.523

Paired t-test is used between preoperative data and postoperative data at 1 month within group respectively.

^* Spherical aberration;

^† root mean square;

^‡ p-value<0.05.

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