Clinical Outcomes of Cataract Surgery Using Nasal Clear Corneal Incision: Safety and Efficacy

Song Minkyung; Jin Hyoung Park; Jae Yong Kim; Myoung Joon Kim; Hungwon Tchah

doi:10.3341/jkos.2017.58.2.140

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Minkyung, Park, Kim, Kim, and Tchah: Clinical Outcomes of Cataract Surgery Using Nasal Clear Corneal Incision: Safety and Efficacy

Original Article

J Korean Ophthalmol Soc 2017;58(2):140-146.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.2.140

Clinical Outcomes of Cataract Surgery Using Nasal Clear Corneal Incision: Safety and Efficacy

Song Minkyung, M.D.¹, Jin Hyoung Park, M.D., PhD², Jae Yong Kim, M.D., PhD¹, Myoung Joon Kim, M.D., PhD¹, Hungwon Tchah, M.D., PhD^1,

¹Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

²Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Address reprint requests to Hungwon Tchah, MD, PhD Department of Ophthalmology, Asan Medical Center, #88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: 82-2-3010-3674, Fax: 82-2-470-6440 E-mail: hwtchah@amc.seoul.kr

Received 6 October 20167 December 2016 Accepted 26 January 2016

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 compare the safety and efficacy of cataract surgery using nasal clear corneal incision (CCI) versus superior or tem-poral CCIs in Korean patients.

Methods

A retrospective comparative study was conducted. Patients underwent cataract surgery using CCI performed by 3 sur-geons between January 2012 and December 2013.The patients were divided into the following 3 groups based on CCI direction: nasal CCIs (group I), superior CCIs (Group II), and temporal CCIs (Group III). To assess usability, surgically induced astigma-tism (SIA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), keratometry reading, and refractive errors at base-line and 1 month after surgery were compared. Operation times were compared between groups. To assess safety, intraoperative complications and wound stability were compared.

Results

A total of 1,374 eyes (Group I, 283 eyes; Group II, 587 eyes; Group III, 504 eyes) were included in the present study. The SIA was not significantly different among the 3 groups. The postoperative mean BCVA, IOP, keratometry reading and spher-ical equivalent as well as the mean operation times were not significantly different between the 3 groups (14.04 ± 3.79 vs. 13.80 ± 3.27 vs. 13.80 ± 3.70; p = 0.473). The rate of intraocular complications and incidence of corneal wound suture were not sig-nificantly different between the 3 groups (1.7% vs. 3.2% vs. 2.3%; p = 0.378).

Conclusions

The safety and efficacy of cataract surgery using nasal CCI were not significantly different compared with the use of temporal or superior CCI. Our results showed that cataract surgery using nasal CCI can be performed safely and conveniently in Korean patients.

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Keywords: Cataract, Nasal incision, Safety, Usability

References

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Figure 1.

Patient groups according to incision locations. The incision locations were selected to correspond to the steep axis of the corneal astigmatism. Gray dotted lines indicate the main clear corneal incision. Black lines indicate the side port incision.

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Figure 2.

Mean changes in ocular parameters. No changes in these parameters, except for mean spherical equivalent (SE), were sig-nificantly different ( p > 0.05). (A) Changes in the mean SE. The amounts of changes between groups were significantly different ( p = 0.000). (B) Changes in mean defocus equivalent. (C) Changes in mean keratometric (K) power. (D) Changes in mean kerato-metric cylindrical (K cyl) power. (E) Changes in best corrected visual acuity (BCVA). (F) Changes in intraocular pressure (IOP). DE = defocus equivalent; Preop = pre-operation; Postop = post-operation.

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Table 1.

Preoperative patient demographics and ocular parameters

	Group I (n = 283)	Group II (n = 587)	Group III (n = 504)	Total (n = 1,374)
Age (years)	61.17 ± 12.55	67.10 ± 10.80	67.42 ± 10.06	65.99 ± 11.19
	(6 to 86)	(12 to 91)	(31 to 93)	(6 to 93)
Sex (n, %)
Male	121 (42.8)	260 (44.3)	222 (44.0)	603 (43.9)
Female	162 (57.2)	327 (55.7)	282 (56.0)	771 (56.1)
Side (n, %)
Right	148 (52.3)	587 (100)	0	729 (53.1)
Left	135 (47.7)	0	504 (100)	645 (46.9)
SE (diopters)	–1.30 ± 3.67	–0.51 ± 2.87	–0.37 ± 2.84	–0.61 ± 3.06
	(–15.00 to 3.63)	(–14.50 to 5.87)	(–14.38 to 5.00)	(–15.00 to 5.87)
DE (diopters)	3.12 ± 3.33	2.68 ± 2.47	2.53 ± 2.35	2.71 ± 2.64
	(0.00 to 16.25)	(0.00 to 15.50)	(0.00 to 15.25)	(0.00 to 16.25)
Mean K (diopters)	43.97 ± 1.79	44.00 ± 1.66	44.01 ± 1.50	44.00 ± 1.63
	(34.86 to 50.38)	(34.25 to 48.63)	(37.75 to 48.13)	(34.44 to 50.38)
BCVA (logMAR)	0.26 ± 0.31	0.28 ± 0.33	0.25 ± 0.26	0.27 ± 0.30
	(0.00 to 1.92)	(0.00 to 2.75)	(0.00 to 1.92)	(0.00 to 2.75)
IOP (mmHg)	15.46 ± 3.07	15.29 ± 3.42	15.58 ± 3.48	15.44 ± 3.38
	(8 to 26)	(8 to 27)	(8 to 27)	(8 to 27)

Values are presented as mean ± SD (range) or n (%).

SE = spherical equivalence; DE = defocus equivalent; mean K = mean keratometric value; BCVA = best corrected visual acuity; IOP = in-traocular pressure.

Table 2.

Postoperative safety and usability outcomes: intraoperative complications, SIA, incidence of corneal wound sutures

	Group I (n = 283)	Group II (n = 587)	Group III (n = 504)	Total (n = 1,374)	p-value
Complication	6 (2.1)	4 (0.7)	8 (1.6)	18 (1.3)	0.171^*
Suture	9 (3.2)	10 (1.7)	12 (2.4)	31 (2.3)	0.378^*
Op. time (min)	13.80 ± 3.27	14.04 ± 3.79	13.80 ± 3.70	13.90 ± 3.66	0.473^†
	(9 to 25)	(9 to 31)	(9 to 29)	(9 to 31)
BCVA (logMAR)	0.09 ± 0.21	0.10 ± 0.22	0.09 ± 0.17	0.09 ± 0.20	0.407^†
	(0.00 to 1.92)	(0.00 to 2.75)	(0.00 to 1.92)	(0.00 to 2.75)
IOP (mmHg)	14.00 ± 3.07	14.02 ± 3.33	14.08 ± 3.22	14.03 ± 3.23	0.927^†
	(8 to 25)	(8 to 26)	(8 to 25)	(8 to 27)

Values are presented as mean ± SD (range) or n (%).

SIA = surgically induced astigmatism; Complication = intraoperative complication; Suture = incidence of corneal wound suture; Op. time = mean operation time (min); BCVA = best corrected visual acuity; IOP = intraocular pressure.

^* Chi-square test

^† One-way analysis of variance (ANOVA) test.

Table 3.

Postoperative efficacy outcomes: ocular parameters

	Group I (n = 283)	Group II (n = 587)	Group III (n = 504)	Total (n = 1,374)	p-value^*
SE (diopters)	–0.95 ± 1.21	–0.76 ± 1.04	–0.75 ± 1.02	–0.80 ± 1.07	0.025
	(–5.75 to 1.00)	(–5.25 to 1.63)	(–4.90 to 1.13)	(–5.75 to 1.63)
DE (diopters)	1.73 ± 1.32	1.69 ± 1.15	1.57 ± 1.11	1.65± 1.17	0.115
	(0.00 to 6.00)	(0.00 to 6.75)	(0.00 to 6.55)	(0.00 to 6.75)
Mean K (diopters)	43.96 ± 1.67	43.99 ± 1.69	44.02 ± 1.49	44.00 ± 1.61	0.851
	(35.13 to 48.75)	(34.25 to 48.63)	(37.75 to 48.13)	(34.25 to 48.79)
SIA (diopters)	0.55 ± 0.41	0.51 ± 0.42	0.49 ± 0.40	0.51 ± 0.41	0.153
	(0.00 to 1.98)	(0.00 to 1.98)	(0.00 to 1.90)	(0.00 to 1.98)

Values are presented as mean ± SD (range).

SE = spherical equivalence; DE = defocus equivalent; Mean K = mean keratometric value; SIA = surgically induced astigmatism.

^* One-way analysis of variance (ANOVA).

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