The 12 o'clock incision was associated with a statistically insignificant increase in AA 2 years postoperatively and the lateral incision, with a statistically significant decrease. We currently recommend routine use of clear corneal incisions in cataract surgery.

Clear corneal cataract surgery leads to a predictable reduction in astigmatism when performed on the steeper axis with a small, no-stitch incision. Larger sutured incisions are not suitable for planned refractive changes but are still recommended in certain cases such as hard cataract and glaucoma.

Purpose: Do foldable acrylic lenses yield not only reduced posterior capsular opacification but also significant refractive advantages? Patients and Methods: 147 cataract patients including 47 with spherical corneas and 100 with preoperative astigmatism of 0.8 ± 0.7 dpt were treated in one of two ways: 70 patients received 5.5-mm Acrysof lens implants through 3.2-mm outer and 4-mm inner temporal clear corneal openings (stretch incision); 77 patients received 5-mm PMMA lenses through temporal clear corneal incisions of 4.1-mm outer and 6.5-mm inner diameter incisions. Corneal topography was examined in all patients before the operations as well as 3 days and 6 months after the operations. Results: 6 months after the operations, we observed a surgically induced astigmatism of 0.4 ± 0.2 dpt for the 3.2-mm incisions compared to 0.8 ± 0.7 dpt for the 4.1-mm incisions; evaluation according to Holladay of the preoperative spherical corneas yielded a with-the-wound change of 0.0 ± 0.3 dpt after 3.2-mm incisions versus 0.6 ± 0.7 dpt after 4.1-mm incisions. The difference in astigmatism for the two types of incisions was statistically significant (p = 0.001). Conclusion: Acrysof lens implantation is especially useful for patients with spherical corneas because of avoidance of postoperative astigmatism. The 4.1-mm corneal incision using PMMA lens implants can be used on the steep meridian to reduce preoperative astigmatism.

No abstract

PURPOSE: To assess long-term corneal stability of self-sealing clear corneal stretch incisions with implantation of 5 mm polymethylmethacrylate (PMMA) intraocular lenses. METHODS: Two hundred consecutive eyes of 3500 cataract patients who had capsulorhexis, phacoemulsification, and preparation of a 1.5 to 2.0 mm corneal tunnel that had an external width of 4.0 to 4.1 mm and an internal width of 6.5 to 7.0 nun (stretch incision), and implantation of a 5 mm PMMA intraocular lens were evaluated clinically and statistically. Slit-lamp microscopy, keratometry, and corneal topography were performed preoperatively and postoperatively after 1 week, 1, 2, and 3 years. RESULTS: The mean surgically induced astigmatism following superior corneal incision amounted to 1.59 ± 1.06 D after 3 years; following lateral corneal incision, mean surgically induced astigmatism was 0.84 ± 0.68 D. There were no corneal complications in the long-term follow-up study. CONCLUSION: Our 5-year experience shows that the self-sealing clear corneal stretch incision in connection with implantation of a 5 mm polymethylmethacrylate intraocular lens induces approximately 1.00 D of astigmatism. We prefer the lateral incision and recommend the superior incision only for high preoperative with-the-rule astigmatism. [J Refract Surg 1998;14:455-458]