title: Torque and flattening effects of clear corneal temporal and on-axis incisions for phacoemulsification.
abstract: OBJECTIVE
  To compare the torque and flattening effect induced by temporal or on-axis clear corneal incisions (CCIs) for phacoemulsification.
  
  
  METHODS
  Moorfields Eye Hospital, London, United Kingdom.
  
  
  METHODS
  Randomized controlled clinical trial on 62 eyes with cataract and mild to moderate corneal astigmatism (<2.60 diopters [D]) having phacoemulsification with a temporal CCI (temporal group) or on-axis CCI (on-axis group). Corneal astigmatism was assessed by corneal topography preoperatively and 3 weeks after surgery. The meridian of the incisions was marked on the cornea before local anesthesia was given to avoid anesthesia-related cyclotorsion. The surgically induced astigmatism (SIA) vector, torque, flattening effect, and accuracy of incision placement were analyzed in the 2 groups and compared with a paired t test.
  
  
  RESULTS
  Three weeks after surgery, the on-axis CCI induced slightly more flattening of the meridian of the incision (mean -0.63 +/- 0.57 D [SD]) than the temporal CCI (mean -0.50 +/- 0.44 D); however, the differences were not statistically significant (P = .31). Simple algebraic difference showed a mean increase in astigmatism magnitude of 0.12 +/- 0.52 D in the temporal group and a mean reduction of 0.21 +/- 0.53 D in the on-axis group (P = .02). The mean absolute torque was 0.28 +/- 0.27 D and 0.53 +/- 0.37 D, respectively (P<.005). The absolute angle of error of incision placement (alpha) was greater after on-axis CCIs (mean 25.9 +/- 20.1 degrees) than after temporal CCIs (mean 14.5 +/- 14.3 degrees) (P = .01).
  
  
  CONCLUSIONS
  In eyes with preoperative astigmatism less than 2.60 D, on-axis CCI phacoemulsification induced slightly more flattening along the incision meridian than temporal CCI phacoemulsification, although the differences were not significant. The on-axis CCI was associated with significantly greater absolute torque and angle of error than the temporal CCI. These factors could limit the benefit of placing the incision on axis when the aim is to reduce preoperative astigmatism in phacoemulsification.
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom. edmondoborasio@gmail.com
authors.forename: Edmondo
authors.initials: E
authors.lastname: Borasio
authors.forename: Jodhbir S
authors.initials: JS
authors.lastname: Mehta
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Maurino
mesh_terms: D000368:Aged; D001251:Astigmatism / Q000503:physiopathology*; D002386:Cataract / Q000150:complications; D003315:Cornea / Q000601:surgery*; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D019591:Pseudophakia / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology