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Jeon, Park, and Kim: Effect of the Corneal Incision Direction Using an Image-guided System on Residual Astigmatism
Original Article

J Korean Ophthalmol Soc 2018;59(6):505-510.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.6.505

Effect of the Corneal Incision Direction Using an Image-guided System on Residual Astigmatism

Seung Hee Jeon, MD, Chang Hyun Park, MD, Hyun Seung Kim, MD, PhD

Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 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 07345, Korea Tel: 82-2-3779-1520, Fax: 82-2-761-6869 E-mail: sara514@catholic.ac.kr

Received 14 February 2018       Revised 11 April 2018       Accepted 4 June 2018

Copyright © 2018 Korean Ophthalmological Society

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

We evaluated the effect of corneal incision direction using an image-guided system on cataract surgery.

Methods

We retrospectively reviewed patients who underwent cataract surgery at The Catholic University of Korea Yeouido St. Mary's Hospital. The patients were divided into two groups. In group 1 (20 eyes), the corneal incision was made along the steepest axis using the VERION image-guided system (Alcon, Fort Worth, TX, USA). In the control group, group 2 (20 eyes), the incision was made at the vertical or horizontal axis closest to the patient's steepest axis. We compared residual astigmatism and the mean difference in astigmatism before and after cataract surgery between the two groups using an autorefractor keratometer (RK-F1®; Canon, Tokyo, Japan) and a Pentacam system (Oculus, Wetzlar, Germany).

Results

Group 1's residual astigmatism was significantly lower than that of group 2 ([VERION group 1; before, 0.89 ± 0.58 D; after, 0.84 ± 0.51 D; p = 0.049] and [control group 2; before, 1.38 ± 0.62 D; after, 1.24 ± 0.62 D; p = 0.043]). The mean difference in astigmatism before and after cataract surgery for group 1 was also larger than group 2 ([VERION group 1; before, 0.71 ± 0.81 D; after, 0.61 ± 0.69 D; p = 0.034] and [control group 2; before, 0.61 ± 0.69 D; after, 0.43 ± 0.61 D; p = 0.048]).

Conclusions

Using an image-guided system, postoperative residual astigmatism from cataract surgery can be minimized using an incision direction that is aligned with the corneal astigmatic axis.

Keywords: Astigmatism, Cataract, Image-guided system

References

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Figure 1.
Mean difference astigmatism between preoperative and postoperative data. (A) The mean difference of astigmatism was statistically significantly higher in group 1 than in group 2 when measured with autorefractor keratometer. (B) The mean difference of astigmatism was statistically significantly higher in group 1 than in group 2 when measured with pentacam. Preop = preoperative; m = months.
jkos-59-505f1.tif
Figure 2.
Preoperative and postoperative visual acuity (logMAR) between 2 groups. Both group showed improvement in visual acuity after surgery, but the difference between the two groups was not statistically significant. UCVA = uncorrected visual acuity; Preop = preoperative; POD = postoperative day; m = months.
jkos-59-505f2.tif
Table 1.
Preoperative demographic and keratometric data of the subjects (n = 40)
Parameters Group 1 Group 2 p-value
Eyes (n) 20 20  
Male:Female (ratio) 4:16 7:13 0.62*
Mean age (years) 66.27 ± 7.68 68.16 ± 12.06 0.46†
Mean UCVA (logMAR) 0.53 ± 0.29 0.57 ± 0.33 0.82†
Mean BCVA (logMAR) 0.26 ± 0.13 0.30 ± 0.29 0.92†
Mean anterior corneal astigmatism by autorefractor keratometer (D) 1.51 ± 1.00 1.70 ± 0.86 0.26‡
Mean anterior corneal astigmatism by pentacam (D) 1.31 ± 0.72 1.62 ± 0.74 0.13‡

Values are presented as mean ± standard deviation unless otherwise indicated. The astigmatism using the autorefractor keratometer and penta-cam of the second group were measured to be slightly higher than those of the first group, but not statistically significant.

UCVA = uncorrected visual acuity; BCVA = best-corrected visual acuity; D = diopters.

* Chi-square test

† Kolmogorov-smirnov test and Mann Whitney U-test

‡ Kolmogorov-smirnov test and student t-test.

Table 2.
Mean residual astigmatism calculating by autorefractor and pentacam
Parameters
 Group 1 Group 2 p-value*,†
Mean residual anterior corneal astigmatism by autorefractor keratometer (D) POD 1 w 1.03 ± 0.69 1.32 ± 0.67 0.081
POD 1 m 1.15 ± 0.62 1.43 ± 0.68 0.132
POD 2 m 0.89 ± 0.58 1.38 ± 0.62 0.049
Mean residual anterior corneal astigmatism by pentacam (D) POD 1 w 0.94 ± 0.49 1.41 ± 0.68 0.034
POD 1 m 1.03 ± 0.54 1.32 ± 0.68 0.149
POD 2 m 0.84 ± 0.51 1.24 ± 0.62 0.043

Values are presented as mean ± standard deviation unless otherwise indicated.

POD = postoperative day; w = week; m = month(s); D = diopters.

* There was statistically significant less residual astigmatism at POD 2 m when measured with autorefractor keratometer and statistically significant less residual astigmatism at POD 1 w and 2 m when measured with pentacam

† Kolmogorov-smirnov test and student t-test.

Table 3.
Mean difference oastigmatism between preoperative and postoperative data
Parameters Group 1 Group 2 p-value*†
Mean difference of antirior corneal astigmatism by autorefractor keratometer (D) (POD 2 m-preop) 0.71 ± 0.81 0.31 ± 0.82 0.034
Mean difference of anterior corneal astigmatism by pentacam (D) (POD 2 m-preop) 0.61 ± 0.69 0.43 ± 0.61 0.048

Values are presented as mean ± standard deviation unless otherwise indicated.

D = diopters; POD = postoperative day; m = months; preop = preoperative.

* The mean difference of astigmatism was statistically significantly higher in group 1 than in group 2 when measured with autorefractor keratometer and pentacam

† Kolmogorov-smirnov test and student t-test.

Table 4.
Preoperative and postoperative visual acuity (logMAR) between 2 groups
Parameters Group 1 Group 2 p-value*
Preoperative      
 Mean UCVA (logMAR) 0.53 ± 0.29 0.57 ± 0.33 0.82
Postoperative 2 months      
 Mean UCVA (logMAR) 0.22 ± 0.16 0.33 ± 0.26 0.13

Values are presented as mean ± standard deviation unless otherwise indicated. Both group showed improvement in visual acuity after surgery, but the difference between the two groups was not statistically significant.

UCVA = uncorrected visual acuity.

* Kolmogorov-smirnov test and Mann Whitney U-test.

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