ArticleCureus2025
A Comparative Study of Surgically Induced Astigmatism From Temporal and Steep-Axis Clear Corneal Incisions in Phacoemulsification Cataract Surgery.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background Surgically induced astigmatism (SIA) is a critical determinant of visual outcomes after phacoemulsification cataract surgery. The choice of incision site significantly influences postoperative refractive stability. This study compares temporal clear corneal incision (CCI) and steep-axis CCI in terms of SIA, uncorrected visual acuity (UCVA), and corneal stability. Methods This prospective randomized study included 130 patients with senile cataract and preoperative corneal astigmatism ≤1.5 D (diopters), allocated into two groups: Group A (temporal incision, n = 65) and Group B (steep-axis incision, n = 65). All surgeries were performed by a single surgeon using standardized phacoemulsification techniques. Preoperative and postoperative assessments included UCVA, best-corrected visual acuity (BCVA), corneal astigmatism, and SIA calculated using vector analysis (magnitude only). Follow-up was performed at day 1, day 7, and one month. Data were analyzed using independent t-tests and chi-square tests, with p < 0.05 considered significant. Results Baseline characteristics were comparable, though a minor imbalance in preoperative astigmatism was noted. At one month, UCVA was significantly better in the temporal group (p = 0.020), while BCVA showed no intergroup difference. Median SIA was lower with temporal incisions (p = 0.003). Corneal astigmatism was also reduced in Group A at day 7 (p < 0.001) and one month (p < 0.001). At one month, 93.8% of patients in Group A achieved corneal astigmatism ≤0.5 D versus 61.5% in Group B (p < 0.001). No significant differences were observed in with-the-rule (WTR) or against-the-rule (ATR) astigmatism patterns. Conclusion Temporal CCI induced less astigmatism and provided better early visual outcomes compared with steep-axis CCI. While these results support the temporal approach for optimizing refractive outcomes in cataract surgery, interpretation should be cautious given the short follow-up, lack of masking, and limited reporting of vector direction. Larger, long-term studies are warranted to validate these findings.
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