Impact of corneal astigmatism on refractive outcomes after phacoemulsification with implantation of a spherical IOL
N. G. Zavgorodnia, V. Iu. Novikova
Zaporizhzhia State Medical University;Zaporizhzhia (Ukraine)
VISUS clinic; Zaporizhzhia (Ukraine)
TO CITE THIS ARTICLE: Zavgorodnia NG, Novikova VIu. Impact of corneal astigmatism on refractive outcomes after phacoemulsification with implantation of a spherical IOL. J.ophthalmol.(Ukraine).2020;6:3-9. http://doi.org/10.31288/oftalmolzh2021139
Background: To date, particular emphasis is being put to correction of preoperative corneal astigmatism in phacoemulsification, since approximately 30% of the world’s population has astigmatism of at least 0.75D which results in decreased visual acuity after cataract surgery.
Purpose: To assess the effect of corneal astigmatism on refractive outcomes of phacoemulsification with implantation of a spheric intraocular lens (IOL).
Material and Methods: We retrospectively analyzed the outpatient medical records of 39 patients (50 eyes) who received phacoemulsification with a spherical IOL and had corneal astigmatism of 0.5-3.75D (as assessed by keratometry). Eyes were divided into four groups based on the degree of corneal astigmatism. We assessed changes in visual acuity and corneal astigmatism and refractive outcomes of cylindrical correction at one month after surgery.
Results: The greater the presurgical astigmatism, the lower was uncorrected visual acuity at one month after surgery. There was no significant difference (р > 0.05) in change in corneal astigmatism values after phacoemulsification. In group 1 (preoperative astigmatism of 0.75 D or less) and group 2 (preoperative astigmatism of 1.0 to 1.5 D), the mean increase in visual acuity after cylindrical refractive correction was 10% or less, and had no significant impact on the quality of vision. In group 3 (preoperative astigmatism of 1.75 to 2.5 D) and group 4 (preoperative astigmatism of 2.75 D or more), the mean increase in visual acuity was 15% and 25%, respectively.
Conclusion: Surgically induced astigmatism after phacoemulsification had no substantial impact on refractive outcomes. When planning refractive outcomes for eyes with astigmatism after cataract surgery, it should be taken into account that implanting a spherical IOL is acceptable only for eyes with an amount of preoperative astigmatism of 0.75 D or less and vertical axis of astigmatism. Cataract patients with preoperative corneal astigmatism of >0.75 D will require implantation of a toric IOL or a plan for astigmatism correction with another method.
Keywords: cataract, corneal astigmatism, phacoemulsification
1.Leaming D. Practice styles and preferences of ASCRS members —2003 survey. J Cataract Refract Surg. 2004 Apr;30(4):892-900.
2.Wallace RB. Refractive cataract surgery and multifocal lOLs. Thorofare, NJ: SLACK Incorporated. 2000.
3.Vitale S. Prevalence of refractive error in the United States, 1999-2004. Arch Ophthalmol. 2008 Aug;126(8):1111-9.
4.Maliugin BE, Filippov VO. [Our first experience of correcting corneal astigmatism during phacoemulsification using a spherocylindrical IOL]. Novoe v oftal'mologii. 2001;1:15–6. Russian.
5.Black A, Wood J. Vision and falls. Clin Exp Optom. 2005 Jul;88(4):212-22.
6.Melnyk VO. [Experience of implanting an AcrySoft IQ Toric IOL during phacoemulsification in eyes with a high degree of astigmatism]. Proceedings of the Filatov Memorial Lectures conference with international speakers. 24-25 May; Odessa; 2012. p. 74. Ukrainian.
7.Bachuk N Yu. [Experience of implanting a toric intraocular lens in cataract patients with corneal astigmatism]. Mezhdunarodnyi medicinskii zhurnal. 2013;1:112–7. Russian.
8.Khripun КV. [Surgical correction of astigmatism during and after cataract extraction]. Cand Sc (Med) Thesis. St Petersburg, 2016. Russian.
9.Kolomiets VA, Dmytriiev SK, Lazar YuM. [Features of surgically induced astigmatism after phacoemulsification of age-related cataract with IOL implantation]. Oftalmol Zh. 2012;2:5-9.
10.Kolomiets VA, Dmitriev SK, Lazar YuM. [Surgically-induced astigmatism values after phacoemulsification in eyes with different IOP levels and corneal rigidity]. Oftalmol Zh. 2012;6:14-20. Russian.
11.Novytskyi О. [Clinical study of the potential for developing postoperative corneal astigmatism after cataract extraction with tunnel incision]. Cand Sc (Med) Thesis. Kyiv: NMAPO; 2002. Ukrainian.
12.Tyazhev МYu, Shanturova MA, Yur'eva TN, Antipin AG. [Traditional keratotomy and femtolaser arcuate corneal incisions for correcting astigmatism during phacoemulsification]. Sovremennye tekhnologii v oftal'mologii. 2017;6:119-121. Russian.
13.Fediashev GA, Egorov VV, Egorova AV. [Evaluating rotational stability of an AcrySoft IQ Toric IOL after senile cataract phacoemulsification]. Proceedings of the Modern Technologies in Cataract and Refractive Surgery conference with international speakers. Moscow; 2011. p. 210-2. Russian.
The authors declare no conflict of interest which could influence their opinions on the subject or the materials presented in the manuscript.