Intraoperative arcuate transverse keratotomy with phacoemulsification.
OBJECTIVE
To evaluate the efficacy of paired intraoperative arcuate transverse keratotomy at a 7-mm-diameter zone along with a 3.5-mm clear corneal phaco tunnel in the steeper axis to correct pre-existing astigmatism.


METHODS
A prospective randomized case-control study was conducted on 34 eyes of 28 patients with immature senile cataract. They were divided into two groups; in one group (17 eyes) intraoperative arcuate keratotomy was coupled with phacoemulsification in the steeper meridian (arcuate keratotomy group; mean preoperative astigmatism 2.28 +/- 0.89 D) and the other group (17 eyes) phacoemulsification was performed in the steeper meridian without arcuate keratotomy (control group; mean preoperative astigmatism 2.04 +/- 0.50 D). The patients were examined at 1 day, and 1, 4, and 8 weeks postoperatively. Correction of keratometric astigmatism, surgically induced refractive changes, magnitude and axis of cylinder, spherical equivalent refraction, with and against the wound change, and coupling ratio were evaluated.


RESULTS
Mean reduction in keratometric astigmatism in the keratotomy group was 1.26 +/- 0.54 D (P = .0067) and in the control group was 0.48 +/- 0.60 D (P = .0423). The difference in reduction of keratometric astigmatism between the two groups was statistically significant (P = .0296). Surgically induced refractive change at 8 weeks follow-up was 2.15 +/- 1.13 D in the keratotomy group and 1.50 +/- 1.32 D in the control group (P = .046). Coupling ratio was -1.10 +/- 0.43 in the keratotomy group at 8 weeks after surgery while the control group was -0.82 +/- 0.38.


CONCLUSIONS
A combination of intraoperative arcuate keratotomy with steep axis phacoemulsification incision is more effective than steep axis phacoemulsification incision alone in reducing pre-existing astigmatism.
Titiyal
Jeewan S
JS
Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Ophthalmic Sciences, New Delhi, India. titiyal@rediffmail.com
Baidya
Krishna P
KP
Sinha
Rajesh
R
Ray
Manotosh
M
Sharma
Namrata
N
Vajpayee
Rasik B
RB
Dada
Vijay K
VK
D000368:Aged; D001251:Astigmatism / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D016022:Case-Control Studies; D002386:Cataract / Q000150:complications*; D002387:Cataract Extraction / Q000379:methods*; D035061:Control Groups; D003315:Cornea / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D018918:Phacoemulsification; D011184:Postoperative Period; D011446:Prospective Studies; D012029:Refraction, Ocular