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Kevin Shah, Samuel Baharestani, Andrew Miller, Laurence Sperber; Astigmatism Outcomes after 2.75mm/2.8mm Clear Corneal Incisions by Residents in Phacoemulsification Cases. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6560. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze final astigmatism outcomes after 2.75mm/2.8mm clear corneal incisions by senior residents in uncomplicated cataract surgery cases by phacoemulsification. This study compares the amount of surgically induced corneal astigmatism (SICA) by resident cases with the literature average of established attending cases. Superior versus temporal incisions was compared within resident cases as well.
50 eyes from 50 patients were included in this retrospective observational study. Patients were selected from the NYU resident clinics at Bellevue Hospital and New York Veteran’s Affairs Hospital. Pre-operative keratometry measurements were taken by autorefractor for each patient and then measured again at the post-operative one-month visit by the same autorefractor. All patients had minor preoperative corneal astigmatism (<2 diopters) and no previous corneal surgery. Either a 2.75mm or 2.8mm keratome was used for each suture-less case. Only uncomplicated cases were used, which includes cases did not use sutures or a vitrector. All cases were precepted by attending faculty experienced in phacoemulsification cataract surgery with senior residents as the primary surgeon.
The amount of surgically induced corneal astigmatism (SICA) was calculated by using Dr. Hill's formula. All cases combined for a SICA of 0.58D (95% CI, 0.42-0.72), while the literature average of similar attending cases produced a SICA of 0.32 (95% CI, 0.12-0.52)1. Temporal cases had a SICA of 0.59D (95% CI, 0.45-0.73) while superior approaches produced a SICA of 0.58D (95% CI, 0.28-0.88).
Surgically-induced astigmatism by resident physicians mirror previously published reports from 2.75mm/2.8mm clear corneal incisions. Temporal approaches do not produce different rates of astigmatism than superior approaches, regardless if the patient has preoperative with-the-rule or against-the-rule astigmatisms. These findings may help novice surgeons to plan for lens selection, site of wound construction and better anticipate post-operative outcomes for future cases.
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