Comparative study of surgically induced astigmatism: superior versus superotemporal scleral incision performed in rural hospital

Introduction: Phacoemulsification has become a gold standard procedure of cataract extraction in the developed countries. Phacoemulsification is expensive hence manual small incision cataract surgery is a better alternative in developing nations. One of the important cause of poor uncorrected visual activity after cataract extraction is high astigmatism. Incision being the first and most important determinant of postoperative astigmatism. Placement of incision superotemporally is one modification to minimize the high pre-existing ATR astigmatism and improving the postoperative visual outcome. Aim: To study the type and amount of surgically induced astigmatism following superior and superotemporal scleral incision in manual small incision cataract surgery. Design: Prospective randomized comparative clinical study. Methodology: 50 eyes of 50 patients each were randomly assigned for superior scleral incision and superotemporal scleral incision and MSICS with PCIOL implantation were performed. Patients were examined on day 1, day 7, end of 4 weeks and 3 months after surgery. Results: 3 months after surgery, 80% of the patients in superior incision group had ATR astigmatism and 86% of the patients in super temporal incision group had WTR astigmatism. The mean SIA in superotemporal group was significantly less than superior incision group. Conclusion: MSICS performed with superotemporal scleral incision in comparison with superior scleral incision produces significantly less surgically induces astigmatism with better stabilization of refraction.