title: Controlling astigmatism in cataract surgery requiring relatively large self-sealing incisions.
abstract: OBJECTIVE
  To evaluate the results of a modified self-sealing incision for achieving astigmatic neutrality in cataract surgery requiring a 6.0 to 7.0 mm incision as well as the methods of correcting preexisting astigmatism using these incisions.
  
  
  METHODS
  Department of Ophthalmology, Kushimoto Rehabilitation Center, Kushimoto, Japan.
  
  
  METHODS
  To achieve astigmatic neutrality, a frown-shaped, oblique incision-the BENT (between 9 and 12 o'clock) frown-was used. To reduce preexisting against-the-rule or with-the-rule astigmatism, the incisions were placed on the temporal or superior steep astigmatic axis, respectively. A frown incision was used when aiming for mild astigmatic reduction and an arcuate incision when aiming for relatively large astigmatic reduction.
  
  
  RESULTS
  In the 6.0 to 7.0 mm BENT frown incision group, mean flattening was minimal throughout 6 months of follow-up, with a maximum of 0.18 diopter (D) 1 week postoperatively. Surgically induced astigmatism was less than that with other incisions. Ninety-four percent of cases had a difference in absolute astigmatism of less than 0.50 D between preoperatively and 6 months postoperatively. Relatively large flattening was observed in eyes with 6.0 to 7.0 mm steep-axis incisions of superior arcuate, temporal arcuate, superior frown, and temporal frown, with means of 1.03, 0.79, 0.64, and 0.52 D, respectively, at 6 months. Ninety-eight percent of cases had a reduction in preexisting absolute astigmatism postoperatively.
  
  
  CONCLUSIONS
  In cataract surgery using relatively large scleral self-sealing incisions, the BENT frown incision effectively achieved astigmatic neutrality. The incisions on the temporal or superior steep astigmatic axis (with selective shape) reduced astigmatism in almost all cases.
authors.affiliation: Kushimoto Rehabilitation Center, Kushimoto, Wakayama-ken, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Akura
authors.forename: S
authors.initials: S
authors.lastname: Kaneda
authors.forename: S
authors.initials: S
authors.lastname: Hatta
authors.forename: K
authors.initials: K
authors.lastname: Matsuura
mesh_terms: D000368:Aged; D001251:Astigmatism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D002387:Cataract Extraction / Q000009:adverse effects / Q000379:methods*; D003315:Cornea / Q000033:anatomy & histology / Q000601:surgery*; D019781:Corneal Topography; D006801:Humans; D011379:Prognosis; D012029:Refraction, Ocular