Shavina Garg¹, Balbir Singh², PL Jindal³, YN Mathur⁴, Anand Aggarwal¹*, Kamlinder Kaur¹, Indu Khosa¹ and Ravneet Pannu¹

¹Department of Ophthalmology, Government Medical College, Patiala, India
²Director, Guru Teg Bahadur Superspecialty Eye Hospital, Patiala and Member Legislative Assembly, Vidhan Sabha Punjab, Chandigarh, India
³Chief Medical Officer, Dera Hospital, Beas, India
⁴Secretary, Maharaj Jagat Singh Medical Relief Society (MJMRS), Beas, India

*Corresponding Author: Anand Aggarwal, Cornea, Glaucoma and Refractive Surgery Services, Department of Ophthalmology, Government Medical College, Patiala, India.

Received: April 27, 2022; Published:

Abstract

Design: This was a comparative, prospective, randomized study.

Setting: Department of Ophthalmology, Government Medical College, Patiala, Punjab.

Purpose: To compare the efficacy and safety of Opposite Clear Corneal Incision to reduce pre-existing astigmatism after phacoemulsification in tertiary Eye Care centre of India.

In this prospective, comparative study 160 patients planned for phacoemulsification were divided into 2 groups. Group A received a foldable IOL through 3.2 mm clear corneal incision made on the steeper meridian along with a 3.2 mm opposite clear corneal incision in an attempt to reduce pre-existing astigmatism. Group B received a foldable IOL through a single clear corneal incision made on the steeper meridian. The preoperative and postoperative data at day 7, 1 month, 3 months and 6 months, on UCVA, BCVA, astigmatism was compared between the groups.

Results: A total of 160 patients were enrolled in the study. These patients were divided into 2 groups with 80 patients in each group. The mean preoperative astigmatism was 1.40 +/- 0.31 in group A which reduced to 0.61 +/- 0.14 D after 6 months. The mean preoperative astigmatism was 1.34 +/- 0.26 D in group B, which reduced to 0.98 +/- 0.18 D after 6 months of follow up. The average mean astigmatic reduction in group A and B was 0.79 D and 0.30 D respectively. There was a significant difference in mean astigmatism between both the groups after 6 months of follow up (p Value < 0.05). 95% of patients had uncorrected visual acuity between 6/6 - 6/9 in group A whereas 55% patients had UCVA between 6/6 - 6/9 after 6 months (p Value < 0.05). None of the patients had UCVA less than 6/18 in both groups. The BCVA was between 6/6 - 6/9 in 97.5% and 95% of patients in group A and group B respectively, which showed no significant difference in terms of BCVA.

Conclusion: Being an advancement in refractive lenticular surgery, Opposite Clear Corneal Incision is a safe and cost effective procedure in reducing mild to moderate preexisting corneal astigmatism if reliable preoperative corneal topography readings using pentacam are available. They may be employed during phacoemulsification surgery to further enhance visual outcomes and patient satisfaction.

Keywords: Cataract; Phacoemulsification; Opposite Clear Corneal Incision (OCCI); Clear Corneal Incision (CCI); Astigmatism; Visual Acuity

References

1. Singh S., et al. “The prevalence and risk factors for cataract in rural and urban India”. I Indian Journal of Ophthalmology4 (2019): 477.
2. Bachani D., et al. “Visual outcomes after cataract surgery and cataract surgical coverage in India”. International Ophthalmology1 (1999): 49-56.
3. Yoon JH., et al. “Surgically induced astigmatism after 3.0 mm temporal and nasal clear corneal incisions in bilateral cataract surgery”. Indian Journal of Ophthalmology11 (2013): 645.
4. Kj H. “Biometry of 7500 cataractous eye”. American Journal of Ophthalmology 90 (1980): 360-368.
5. Amesbury EC and Miller KM. “Correction of astigmatism at the time of cataract surgery”. Current Opinion Ophthalmology1 (2009): 19-24.
6. Rashad KM. “Laser in situ keratomileusis for myopic astigmatism”. Journal of Refractive Surgery6 (1999): 653-660.
7. Bazzazi N., et al. “Opposite clear corneal incisions versus on-axis incision during phacoemulsification to correct pre-existing astigmatism”. Journal of Ophthalmic and Vision Research2 (2008): 87-90.
8. Hashemian MN., et al. “Femtosecond laser arcuate keratotomy for the correction of postkeratoplasty high astigmatism in keratoconus”. Journal of Research in Medical Sciences 22 (2017): 17.
9. Nichamin LD. “Astigmatism control”. Ophthalmology Clinics of North America 4 (2006): 485-493.
10. Pfleger T., et al. “Long-term course of induced astigmatism after clear corneal incision cataract surgery”. Journal of Cataract and Refractive Surgery1 (1996): 72-77.
11. Bazzazi N., et al. “Opposite clear corneal incisions versus steep meridian incision phacoemulsification for correction of pre-existing astigmatism”. Journal of Ophthalmic and Vision Research 2 (2008): 87.
12. Holladay JT., et al. “Calculating the surgically induced refractive change following ocular surgery”. Journal of Cataract and Refractive Surgery 24 (1992): 57-65.
13. Inuoe T., et al. “Factors that influence the surgical effects of astigmatic keratotomy after cataract surgery”. Ophthalmology 108 (2001): 1269-1274.
14. Matsumoto Y., et al. “Optimal incision sites to obtain an astigmatism-free cornea after cataract surgery with a 3.2 mm sutureless incision”. Journal of Cataract and Refractive Surgery10 (2001): 1615-1619.
15. Rainer G., et al. “Corneal shape changes after temporal and superolateral 3.0 mm clear corneal incisions”. Journal of Cataract and Refractive Surgery8 (1999): 1121-1126.
16. Lever J and Dahan E. “Opposite clear corneal incisions to correct pre-existing astigmatism in cataract surgery”. Journal of Cataract and Refractive Surgery6 (2000): 803-805.
17. Reehan A., et al. “Effect of Opposite Clear Corneal Incision (CCI) on Corneal Higher-Order Aberrations after Phacoemulsification”. The Medical Journal of Cairo University 89 (2021): 1445-1452.
18. Archana T and Daigavane S. “Outcome of Clear Corneal Incision on Steep Meridian in Eye with Pre Existing Corneal Astigmatism after Phacoemulsification”. Journal of Dental and Medical Sciences 11 (2018): 11-18.
19. Bhalla JS., et al. “Evaluation of opposite clear corneal incision in controlling astigmatism in cataract patients undergoing phacoemulsification surgery”. Delhi Journal of Ophthalmology4 (2016): 241-245.
20. Ren Y., et al. “Phacoemulsification with 3.0 and 2.0 mm opposite clear corneal incisions for correction of corneal astigmatism”. Cornea9 (2019): 1105-1110.
21. Tadros A., et al. “Opposite clear corneal incisions on the steep meridian in phacoemulsification: early effects on the cornea”. Journal of Cataract and Refractive Surgery2 (2004): 414-417.
22. Faal NB., et al. “Paired Opposite 4 mm Clear Corneal Incisions on Steep Meridian during Phacoemulsification”. Journal of Current Ophthalmology4 (2021): 400.
23. Khokhar S., et al. “Corneal astigmatism correction with opposite clear corneal incisions or single clear corneal incision: comparative analysis”. Journal of Cataract and Refractive Surgery9 (2006): 1432-1437.
24. Ben Simon GJ and Desatnik H. “Correction of pre-existing astigmatism during cataract surgery: comparison between the effects of opposite clear corneal incisions and a single clear corneal incision”. Graefe's Archive for Clinical and Experimental Ophthalmology 4 (2005): 321-326.
25. Núñez MX., et al. “Consensus on the management of astigmatism in cataract surgery”. Clinical Ophthalmology 13 (2019): 311.

Citation

Citation: Anand Aggarwal., et al. “Efficacy and Safety of Opposite Clear Corneal Incision to Reduce Pre-existing Astigmatism After Phacoemulsification - A Prospective Study".Acta Scientific Ophthalmology 5.6 (2022): 00-00.

Copyright

Copyright: © 2022 Anand Aggarwal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.