Abdul Hameed Siddique, Rabia Ahmed Jalali, Sahira Wasim.
Minimum to nil post cataract astigmatism by clear corneal incisions on the steep meridian.
Pak J Surg Nov ;36(3):255-9.

Background: Blurred vision, monocular diplopia, glare sensation, visual aberrations and asthenopia may cause by astigmatism. The rectification of astigmatism is one of the main aims of modern cataract surgery. Objective: The main objective of current study is to achieve minimum to nil post cataract astigmatism by giving clear corneal incisions on the steep meridian Material and Methods: A cross-sectional study was carried out among 221 consecutive eyes, 221 patients, visited Department of Ophthalmology, Liaquat National Hospital Karachi from 23rd March 2018 to 22nd September 2018. Pre-operative visual acuity documented by auto refractometer and snellen chart. Keratometric reading, axial length and intraocular lens power calculation was done by IOL master. Each patient steep axis will be noted prior to surgery and clear corneal incision with 3.2mm knife will be given on the steep axis, which in turn flattens it, thereby reducing or eliminating the astigmatism. Post-op the patients will be seen on 1st day, 1st week and 3rd week and on each follow up their visual acuity and refraction will be noted and compared with pre-op astigmatism. Data was analyzed by using SPSS-21. Normality was checked by Shapiro wilk test. Friedman test and Wilcoxon Signed Ranks test were applied to compare means at 1st day, 1st week and 3rd week as appropriate. Results: Out of 221 patients, 123 were male and 98 were female. The mean age of patients was 58.00+-4.54 years. Mean K1, K2, AXL and IOL was 43.95+-1.95, 43.93+-1.91, 23.33+-1.31 and 20.83+-3.41 respectively. Spherical refraction was 0.11+-1.01, 0.02+-0.70 and 0.01+-0.37 at 1st day, 1st week and 3rd week respectively while cylindrical refraction was -0.633+-0.96,- 0.42+-0.56, -0.29+-0.39 at 1st day, 1st week and 3rd week respectively. Among 221 patients, 6/6 visual acuity was achieved in 88.7% of patients. We found significant mean spherical refraction difference at 1st day, 1st week and 3rd week, as well as significant, mean cylindrical difference. No significant mean difference was found for 1st week refraction with pre-op-refraction while there was significant mean difference with 3rd week refraction. Conclusion: The utilization of clear corneal incisions of 3.2 mm on steep axis during the routine procedure of phacoemulsification can help in the rectification of mild to moderate pre-existing astigmatism carrying the advantage of using no additional instruments and also having no requirement of any change in the surgical procedure.

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