Three Methods for Correction of Astigmatism during Phacoemulsification

Purpose: To compare the safety and efficacy of three methods for correcting pre‑existing astigmatism during phacoemulsification. Methods: This prospective, comparative, non‑randomized study was conducted from March 2010 to January 2011, and included patients with keratometric astigmatism ≥1.25 D undergoing cataract surgery. Astigmatism was corrected using the following approaches: limbal relaxing incisions (LRI) on the steep meridian, extension and suturing of the phaco incision created at the steep meridian (extended‑on‑axis incision, EOAI), and toric intraocular lens (tIOL) implantation. Keratometric and refractive astigmatism were evaluated 1, 8, and 24 weeks postoperatively. Results: Eighty‑three eyes of 72 patients (35 male and 37 female) with mean age of 62.4 ± 14.3 (range, 41‑86) years were enrolled. The astigmatism was corrected by using the LRI, EOAI and tIOL implantation methods in 17, 33 and 33 eyes, respectively. Postoperative uncorrected distance visual acuity (UDVA) was significantly improved in all three groups. The difference in postoperative UDVA was not statistically significant among the study groups throughout follow‑up except at week 24, when UCVA was significantly better in the tIOL group as compared to the EOAI group (P = 0.024). There is no statistically significant difference of correction index and index of success between three groups at week 24 (P = 0.085 and P = 0.085 respectively). Conclusion: There was no significant difference in astigmatism reduction among the three methods of astigmatism correction during phacoemulsification. Each of these methods can be used at the discretion of the surgeon.