Prospective, randomized vector analysis of astigmatism after three-, one-, and no-suture phacoemulsification.
OBJECTIVE
To compare surgically induced astigmatism and visual outcomes after three-, one-, and no-suture phacoemulsification.


METHODS
Johns Hopkins Hospital, Baltimore, Maryland and Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA.


METHODS
This prospective, randomized study followed 131 patients treated with phacoemulsification with a 5.5 mm self-sealing scleral tunnel and implantation of a 5.5 mm poly(methyl methacrylate) posterior chamber lens. Radial 10-0 nylon sutures were used in the three- and one-suture groups.


RESULTS
Mean astigmatism was greatest in the first postoperative week in all groups and stabilized after 8 weeks. The percentage of patients with with-the-rule (WTR) astigmatism increased from baseline in the one- and three-suture groups and decreased in the sutureless group. Mean uncorrected Snellen acuity was significantly better in the no- and one-suture groups than in the three-suture group at 1 week. There were no significant differences in uncorrected acuity at other times. No statistically significant differences in the surgically induced spherical equivalent were noted among the three groups during the 1 year follow-up. There was significantly less surgically induced keratometric astigmatism in the one-suture group at 4 (P = .03) and 8 (P = .007) weeks postoperatively. At all follow-ups, the sutureless group had the greatest proportion of patients, with significant ATR astigmatic shift (1 week, 17%; 4 weeks, 32%); and the lowest proportion of patients with significant WTR astigmatic shift (10% after 1 week). At 4 weeks, the percentage of patients with significant WTR shift in the one-suture group dropped to that in the sutureless group (10%); however, those in the one-suture group had less ATR astigmatic shift (16%).


CONCLUSIONS
Sutureless and one-suture surgery resulted in a low percentage of WTR induced astigmatism 4 weeks postoperatively. Compared with sutureless surgery, the one-suture surgery resulted in less ATR shift.
Azar
D T
DT
Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
Stark
W J
WJ
Dodick
J
J
Khoury
J M
JM
Vitale
S
S
Enger
C
C
Reed
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001251:Astigmatism / Q000209:etiology* / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects* / Q000379:methods; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications; D011446:Prospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
D019904:Polymethyl Methacrylate