Induced Astigmatism With 2.2-and 3.0-mm Coaxial Phacoemulsification Incisions

PURPOSE: To evaluate the difference between 2.2-mm incision micro-coaxial phacoemulsification and traditional 3.0-mm coaxial phacoemulsification with respect to surgically induced astigmatism after temporally oriented clear corneal incision cataract surgery. METHODS: This prospective, randomized, intra-patient controlled study comprised 22 patients who underwent clear corneal cataract surgery in both eyes. One eye received 2.2-mm incision micro-coaxial phacoemulsification with intraocular lens (IOL) implantation and the fellow eye received traditional 3.0 mm coaxial incision phacoemulsification with IOL implantation. The 2.2-mm incisions were created with a diamond keratome after a 200-mu m groove was constructed in clear cornea at the temporal limbus. The 3.0-mm incisions were created without a pre-cut groove, using a metal keratome. All cases were uncomplicated. Pre- and postoperative keratometric astigmatism at 6 weeks was measured using a hand held Nikon Retinomax K-plus 2 Autorefractor. Three methods were used to analyze the surgically induced astigmatism (SIA) data: 1) algebraic analysis of the magnitude of keratometric astigmatism induced by the surgery, 2) magnitude of SIA by vector analysis, and 3) aggregate analysis of astigmatism using vector analysis. RESULTS: The mean change in the magnitude of keratometric astigmatism was 0.10 +/- 0.08 dopters (D) with the 2.2 mm micro-coaxial incisions and 0.32 +/- 0.20 D with the 3.0-mm traditional incisions (P=.0002). Using vector analysis, the mean magnitude of SIA was 0.35 +/- 0.21 D with the 2.2-mm incisions and 0.67 +/- 0.48 D (P=.006) with the 3.0-mm incisions. CONCLUSIONS: Surgically induced astigmatism with 2.2-nm micro-coaxial incisions and traditional 3.0-mm clear corneal incisions with intra-patient control resulted in statistically and clinically significant reduction in surgically induced astigmatism with the smaller incision size. [J. Refract Surg. 2009;25:21-24.]