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      Comparison of surgically induced astigmatism between horizontal and X-pattern sutures in the scleral tunnel incisions for manual small incision cataract surgery

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          Abstract

          Background:

          Two types of popular scleral tunnel sutures in the manual small incision cataract surgery (MSICS) are horizontal and X-pattern sutures. Surgically induced corneal astigmatism (SIA) is a useful indicator of the suturing effect.

          Aims:

          To compare SIA between horizontal and X-pattern sutures in the scleral tunnel incisions for MSICS.

          Design:

          Prospective, nonrandomized comparative trial.

          Materials and Methods:

          After superior scleral tunnel incision and capsulorhexis, the nucleus was prolapsed into the anterior chamber and delivered. The wound was sutured with either horizontal or X-pattern suture. The simulated keratometry values were derived from the corneal topography preoperatively and 1.5 and 3 months postoperatively.

          Statistical Analysis:

          The SIA was calculated by Cartesian coordinates based analysis.

          Results:

          Sixty-four patients (32 patients in each group) were included in the study. In the horizontal suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.87 × 1° and 1.11 × 180°, respectively, showing induction of against-the-rule astigmatism. In the X-pattern suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.61 × 97° and 0.66 × 92°, respectively, showing induction of mild with-the-rule astigmatism. The difference between the amount of SIA at 1.5 and 3 months after surgery was small.

          Conclusion:

          In the MSICS, the X-pattern sutures were preferred to the horizontal sutures in the patients without significant preoperative steepening in line with the central meridian of the incision. In the cases with significant preoperative steepening, sutureless surgery or horizontal sutures were preferred. Corneal astigmatism in the patients undergoing MSICS was stable at 1.5 months after the surgery.

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          Most cited references 27

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          A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal.

          To compare the efficacy and visual results of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery (SICS) for the treatment of cataracts in Nepal. Prospective, randomized comparison of 108 consecutive patients with visually significant cataracts. settings: Outreach microsurgical eye clinic. patients: One hundred eight consecutive patients with cataracts were assigned randomly to receive either phacoemulsification or SICS. intervention Cataract surgery with implantation of intraocular lens. main outcome measures: Operative time, surgical complications, uncorrected and best-corrected visual acuity (BCVA), astigmatism, and central corneal thickness (CCT). Both surgical techniques achieved excellent surgical outcomes with low complication rates. On postoperative day 1, the groups had comparable uncorrected visual acuity (UCVA) (P = 0.185) and the SICS group had less corneal edema (P = 0.0039). At six months, 89% of the SICS patients had UCVA of 20/60 or better and 98% had a best-corrected visual acuity (BCVA) of 20/60 or better vs 85% of patients with UCVA of 20/60 or better and 98% of patients with BCVA of 20/60 or better at six months in the phaco group (P = 0.30). Surgical time for SICS was much shorter than that for phacoemulsification (P < .0001). Both phacoemulsification and SICS achieved excellent visual outcomes with low complication rates. SICS is significantly faster, less expensive, and less technology dependent than phacoemulsification. SICS may be the more appropriate surgical procedure for the treatment of advanced cataracts in the developing world.
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            Safety and efficacy of phacoemulsification compared with manual small-incision cataract surgery by a randomized controlled clinical trial: six-week results.

            To compare the efficacy, safety, and refractive errors of astigmatism after cataract surgery by phacoemulsification and manual small-incision cataract surgery techniques. Masked randomized control clinical trial. Four hundred eyes of 400 patients, 1:1 randomization with half in each arm of the trial. A total of 400 eyes was assigned randomly to either phacoemulsification or small-incision groups after informed consent and were operated on by 4 surgeons. They were masked to the technique of surgery before, during, and after cataract surgery and followed up to 1 year after surgery. The intraoperative and postoperative complications, uncorrected and best-corrected visual acuity, and astigmatism were recorded at 1 and 6 weeks postoperatively. The proportion of patients achieving visual acuity better than or equal to 6/18 with and without spectacles after cataract surgery in the operated eye up to 6 weeks, postoperative astigmatism, and complications during and after surgery. This article reports clinical outcomes up to 6 weeks. Three hundred eighty-three of 400 (95.75%) patients completed the 1-week follow-up, and 372 of 400 (93%) patients completed the 6-week follow-up. One hundred thirty-one of 192 (68.2%) patients in the phacoemulsification group and 117 of 191 (61.25%) patients in the small-incision group had uncorrected visual acuity better than or equal to 6/18 at 1 week (P = 0.153). One hundred fifty of 185 (81.08%) patients of the phacoemulsification group and 133 of 187 (71.1%) patients of the small-incision group (P = 0.038) were better than or equal to 6/18 at the 6-week follow-up for presenting visual activity. Visual acuity improved to > or = 6/18 with best correction in 182 of 185 patients (98.4%) and 184 of 187 (98.4%) patients (P = 0.549), respectively. Poor outcome (postoperative visual acuity < 6/60) was noted in 1 of 185 (0.5%) in the phacoemulsification group and none in the small-incision group. The mode of astigmatism was 0.5 diopters (D) for the phacoemulsification group and 1.5 D for the small-incision group, and the average astigmatism was 1.1 D and 1.2 D, respectively. There was an intra-surgeon variation in astigmatism. The phacoemulsification group had 7 posterior capsular rents compared with 12 in the small-incision group, but the phacoemulsification group had more corneal edema on the first postoperative day. Both the phacoemulsification and the small-incision techniques are safe and effective for visual rehabilitation of cataract patients, although phacoemulsification gives better uncorrected visual acuity in a larger proportion of patients at 6 weeks.
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              Why do phacoemulsification? Manual small-incision cataract surgery is almost as effective, but less expensive.

              To compare the cost of phacoemulsification with foldable lenses with that of manual small-incision cataract surgery (SICS) in a hospital setting. Average cost comparision between 2 surgical techniques. Four hundred patients and 4 surgeons. A single masked randomized controlled clinical trial was conducted previously to compare safety and efficacy of the 2 techniques for rehabilitation of the cataract patient. The fixed-facility and recurrent (consumables) cost for phacoemulsification and SICS were calculated based on information collected at different sources using standard norms. Average cost per procedure was calculated by dividing the total cost by the number of procedures performed. Average fixed-facility cost and average consumable cost for both the techniques. The average cost of a phacoemulsification surgery for the hospital was Indian rupees (Rs) 1978.89 ($42.10), and the average cost for a SICS surgery was Rs 720.99 ($15.34), of which Rs 500.99 ($10.65) was the fixed-facility cost common to both. Phacoemulsification cost was more because of the foldable lens used. Phacoemulsification needs additional cost for the machine (depreciation), replenishment of parts, and annual maintenance contract. Manual SICS is far more economical than phacoemulsification. Its visual result is comparable with that of phacoemulsification and is as safe.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0301-4738
                1998-3689
                July 2015
                : 63
                : 7
                : 606-610
                Affiliations
                Farabi Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                Correspondence to: Dr. Arash Mirmohammadsadeghi, Farabi Eye Hospital, Ghazvin Square, Tehran, Iran. E-mail: a1sadeghi@ 123456yahoo.com
                Article
                IJO-63-606
                10.4103/0301-4738.167113
                4652252
                26458479
                Copyright: © Indian Journal of Ophthalmology

                This is an open access article distributed under the terms of the Creative Commons Attribution NonCommercial ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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