Comparison of Higher Order Aberrations and Astigmatism after On-Axis Small Incision Cataract Surgery

Hyun Jin Jeong; Byung Ju Jung; Hyung Bin Hwang; Hyun Seung Kim

doi:10.3341/jkos.2014.55.2.182

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Jeong, Jung, Hwang, and Kim: Comparison of Higher Order Aberrations and Astigmatism after On-Axis Small Incision Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2014;55(2):182-189.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.2.182

Comparison of Higher Order Aberrations and Astigmatism after On-Axis Small Incision Cataract Surgery

Hyun Jin Jeong, MD, Byung Ju Jung, MD, Hyung Bin Hwang, MD, Hyun Seung Kim, MD, PhD

Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea

Address reprint requests to Hyun Seung Kim, MD, PhD Department of Ophthalmology, The Catholic University of Korea Yeouido St. Mary’s Hospital, #10 63-ro, Yeongdeungpo-gu, Seoul 150-713, Korea, Tel: 82-2-3779-1243, Fax: 82-2-761-6869, E-mail: sara514@catholic.ac.kr

Received 7 September 201317 September 2013 Accepted 7 December 2013

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 assess the changes of corneal astigmatism and higher order aberrations (HOAs) of the anterior and posterior corneal surface after cataract surgery with on-axis clear corneal incision in eyes with-the-rule (WTR) astigmatism and against-the-rule (ATR) astigmatism.

Methods

This study included 50 patients who underwent phacoemulsification and IOL insertion through a 2.8-mm on-axis clear corneal incision. The eyes were divided into two groups: (1) 26 eyes with WTR astigmatism with a superior incision and (2) 24 eyes with ATR astigmatism with a temporal incision. During the follow-up period, visual acuity was measured, and the surgically induced astigmatism (SIA) and HOAs of the anterior and posterior corneal surface were measured with Pentacam^® (Occlus, Wetzlar, Germany) preoperatively and 1 week, 1 month, and 2 months postoperatively.

Results

There were no significant differences in UCVA and BCVA between the two groups. HOAs increased in both groups 1 week after surgery, but no significant differences were found between the groups (p > 0.05). Surgically induced astigmatism was larger in the WTR group than in the ATR group (p < 0.05). At postoperative 2 months, there were significant differences in HOAs between the two groups, and there were statistically significant differences in HOAs, oblique trefoil at front side, and in HOAs, horizontal coma at rear side (p < 0.05).

Conclusions

In conclusion, superior incision in eyes with WTR astigmatism resulted in higher SIA compared to temporal incision in eyes with ATR astigmatism. Moreover, HOAs was significantly decreased in eyes with WTR astigmatism with superior incision. Thus, superior incision could be more effective in reducing corneal astigmatism in eyes with WTR astigmatism.

Keywords: Against-The-Rule (ATR), Higher Order Aberrations (HOAs), On-axis Incision, Surgically Induced Astigmatism (SIA), With-The-Rule (WTR)

References

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Figure 1.

Change of topographic astigmatism. Values are presented as mean ± SD. Pre-op = preoperative; Post-op 1 w = postoperative 1 week; Post-op 1 m = postoperative 1 month; Post-op 2 m = postoperative 2 months. p-value by Mann-Whitney U test. There is no statistically significant difference between two groups (p > 0.05).

Figure 2.

Surgically-induced astigmatism calculated by vector analysis. Values are presented as mean ± SD. Pre-op = pre-operative; Post-op 1 w = postoperative 1 week; Post-op 1 m = postoperative 1 month; Post-op 2 m = postoperative 2 months. p-value by Mann-Whitney U test (^* p < 0.05).

Figure 3.

Comparision of corneal total higher order aberrations RMS and oblique trefoil (Z(3,-3)) RMS on front side in two groups. Z = zernike coefficients; RMS = root mean square; Pre-op = preoperative; Post-op 1 w = postoperative 1 week; Post-op 1 m = postoperative 1 month; Post-op 2 m = postoperative 2 months. p-value by Mann-Whitney U test (^* p < 0.05).

Figure 4.

Comparision of corneal total higher order aberations on front side in two groups. Z = zernike coefficients; RMS = root mean square; HOA = total higher order aberrations (3rd-6th order); Pre-op = preoperative; Post-op 1 w = postoperative 1 week; Post-op 1 m = postoperative 1 month; Post-op 2 m = postoperative 2 months. p-value by Wilcoxon rank test (^* p < 0.05).

Figure 5.

Comparision of corneal total higher order aberations RMS and Horizontal coma (Z(3, 1)) RMS on rear side in two groups. Z = zernike coefficients; RMS = root mean square; HOA = total higher order aberrations (3rd-6th order); Pre-op = preoperative; Post-op 1 w = postoperative 1 week; Post-op 1 m = postoperative 1 month; Post-op 2 m = postoperative 2 months. p-value by Mann-Whitney U test (^* p < 0.05).

Figure 6.

Comparision of corneal total higher order aberrations on rear side in two groups. Z = zernike coefficients; RMS = root mean square; HOA = total higher order aberrations (3rd-6th order); Pre-op = preoperative; Post-op 1 w = postoperative 1 week; Post-op 1 m = postoperative 1 month; Post-op 2 m = postoperative 2 month. p-value by Wilcoxon rank test. There is no statistically significant difference among preoperative and postoperative 1 week, postoperative 1 month, postoperative 2 months in two groups, respectively (p > 0.05).

Table 1.

Patient characteristics

Variables	With the rule (Group 1)	Against the rule (Group 2)	p-value^*
No. of eyes	26	24
Laterality (OD:OS)	14 : 12	12 : 12
Sex (M:F)	13 : 13	11 : 13
Age (years)	68.40 ± 6.87	73.90 ± 10.83	0.062
Pachymetry (μm)	563.64 ± 31.19	569.55 ± 33.75	0.558
Endothelial cell count (cell/mm²)	2703 ± 457.13	2825 ± 367.95	0.527
Axial length (mm)	23.95 ± 0.11	23.55 ± 0.53	0.424

Values are presented as mean ± SD.

^* By Mann-Whitney U test.

Table 2.

Data summary of UCVA, BCVA, SE and topographic astigmatism

		With the rule (Group 1)	Against the rule (Group 2)	p-value^*
Pre-op	UCVA (log MAR)	0.78 ± 0.49	0.79 ± 0.43	0.25
	BCVA (log MAR)	0.54 ± 0.37	0.59 ± 0.50	0.73
	SE (diopter)	2.29 ± 2.31	2.58 ± 1.90	0.829
	Topographic astigmatism (diopter)	1.25 ± 0.85	1.09 ± 0.76	0.23
Post-op 2 m	UCVA (log MAR)	0.19 ± 0.32	0.18 ± 0.36	0.08
	BCVA (log MAR)	0.05 ± 0.03	0.04 ± 0.07	0.08
	SE (diopter)	-0.40 ± 0.42	-0.39 ± 0.32	0.501
	Topographic astigmatism (diopter)	0.76 ± 0.19	0.78 ± 0.27	0.231

Values are presented as mean ± SD.

UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; SE = spherical equivalent; Pre-op = preoperative; Post-op 2 m = post-operative 2 months.

^* By Mann-Whitney U test.

Table 3.

Postoperative changes of corneal aberrations on the front side

		Pre-op	Post-op 1 w	Post-op 1 m	Post-op 2 m
Z(3,-1)	Group 1^*	0.210 ± 0.024	0.251 ± 0.018	0.232 ± 0.025	0.216 ± 0.026
Vertical coma	Group 2^†	0.231 ± 0.055	0.274 ± 0.014	0.280 ± 0.027	0.251 ± 0.057
RMS (μm)	p-value	0.649	0.287	0.468	0.14
Z(3, 1)	Group 1^*	0.208 ± 0.221	0.249 ± 0.082	0.219 ± 0.022	0.197 ± 0.032
Horizontal coma	Group 2^†	0.245 ± 0.055	0.272 ± 0.014	0.251 ± 0.05	0.235 ± 0.036
RMS (μm)	p-value	0.875	0.421	0.172	0.09
Z(3, -3)	Group 1^*	0.052 ± 0.010	0.063 ± 0.012	0.068 ± 0.013	0.038 ± 0.012
Oblique trefoil	Group 2^†	0.086 ± 0.019	0.096 ± 0.012	0.080 ± 0.079	0.092 ± 0.041
RMS (μm)	p-value	0.147	0.053	0.310	0.01^‡
Z(3, 3)	Group 1^*	0.052 ± 0.033	0.066 ± 0.015	0.063 ± 0.028	0.049 ± 0.013
Horizontal trefoil	Group 2^†	0.051 ± 0.075	0.057 ± 0.047	0.059 ± 0.098	0.052 ± 0.042
RMS (μm)	p-value	0.482	0.785	0.612	0.745
Z(4, 0)	Group 1^*	0.317 ± 0.028	0.308 ± 0.024	0.358 ± 0.039	0.311 ± 0.034
Spherical aberration	Group 2^†	0.325 ± 0.047	0.347 ± 0.075	0.348 ± 0.049	0.336 ± 0.074
RMS (μm)	p-value	0.574	0.214	0.574	0.672
HOA	Group 1^*	0.506 ± 0.034	0.512 ± 0.029	0.480 ± 0.036	0.455 ± 0.027
	Group 2^†	0.523 ± 0.078	0.531 ± 0.045	0.516 ± 0.062	0.507 ± 0.027
RMS (μm)	p-value	0.613	0.06	0.186	0.04^‡

Values are presented as mean ± SD.

Z = zernike coefficients; RMS = root mean square; HOA = total higher order aberrations (3rd-6th order); Pre-op = preoperative; Post-op 1 w = postoperative 1 week; Post-op 1 m = postoperative 1 month; Post-op 2 m = postoperative 2 months.

^* With the rule

^† Against the rule

^‡ By Mann-Whitney U test (p < 0.05).

Table 4.

Postoperative changes of corneal aberrations on the rear side

		Pre-op	Post-op 1 w	Post-op 1 m	Post-op 2 m
Z(3, -1)	Group 1^*	0.044 ± 0.006	0.054 ± 0.012	0.061 ± 0.007	0.037 ± 0.009
Vertical coma	Group 2^†	0.050 ± 0.014	0.055 ± 0.021	0.071 ± 0.012	0.033 ± 0.015
RMS (μm)	p-value	0.281	0.253	0.749	0.924
Z(3, 1)	Group 1^*	0.024 ± 0.003	0.063 ± 0.004	0.053 ± 0.004	0.021 ± 0.002
Horizontal coma	Group 2^†	0.028 ± 0.012	0.029 ± 0.010	0.054 ± 0.006	0.053 ± 0.007
RMS (μm)	p-value	0.524	0.02^‡	0.456	0.008^‡
Z(3, -3)	Group 1^*	0.029 ± 0.007	0.037 ± 0.058	0.035 ± 0.010	0.024 ± 0.008
Oblique trefoil	Group 2^†	0.028 ± 0.011	0.034 ± 0.010	0.046 ± 0.009	0.031 ± 0.006
RMS (μm)	p-value	0.069	0.267	0.075	0.13
Z(3, 3)	Group 1^*	0.024 ± 0.003	0.029 ± 0.005	0.024 ± 0.003	0.021 ± 0.004
Horizontal trefoil	Group 2^†	0.031 ± 0.004	0.035 ± 0.110	0.034 ± 0.007	0.028 ± 0.006
RMS (μm)	p-value	0.07	0.09	0.144	0.161
Z(4, 0)	Group 1^*	0.142 ± 0.007	0.167 ± 0.010	0.151 ± 0.008	0.163 ± 0.017
Spherical aberration	Group 2^†	0.175 ± 0.010	0.125 ± 0.012	0.116 ± 0.009	0.131 ± 0.010
RMS (μm)	p-value	0.12	0.45	0.53	0.45
HOA	Group 1^*	0.204 ± 0.011	0.266 ± 0.017	0.201 ± 0.010	0.185 ± 0.013
	Group 2^†	0.221 ± 0.019	0.240 ± 0.030	0.220 ± 0.011	0.200 ± 0.024
RMS (μm)	p-value	0.4	0.214	0.186	0.04^‡

Values are presented as mean ± SD.

Z = zernike coefficient; RMS = root mean square; HOA = total higher order aberrations (3rd-6th order); Pre-op = preoperative; Post-op 1 w = postoperative 1 week; Post-op 1 m = postoperative 1 month; Post-op 2 m = postoperative 2 months.

^* With the rule

^† Against the rule

^‡ By Mann-Whitney U test (p < 0.05).

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