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Lamellar keratotomy to correct astigmatism in cataract surgery

  • Clinical Investigation
  • Published:
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Abstract

Background

For the correction of astigmatism in cataract surgery, several incisional procedures have been developed. In this study, a modification of lamellar keratotomy was evaluated to correct astigmatism in cataract surgery.

Methods

Prospectively 32 eyes of 25 patients with a preoperative astigmatism greater than 1.5 D were studied. All patients were treated with lamellar keratotomy with an incision width of 6 mm and a radial length of 1.5 mm placed at the limbus in the steep meridian. Phacoemulsification and IOL implantation were then performed through a 3.2-mm corneal tunnel incision. After 4 weeks, mean astigmatism, mean corneal power changes, and mean surgically-induced astigmatism derived from vector analysis in the central 3-mm optical zone were determined.

Results

The mean astigmatism decreased from 2.75±0.80 D preoperatively to 1.58±0.91 D after 4 weeks (P<0.001). There were no significant changes (P=0.614) of the mean corneal power. The mean surgically-induced astigmatism was 2.59±1.50 D. The induced changes were more accentuated in superior incisions. In corneal topography, 78% of the treated eyes revealed a characteristic threefold pattern of the mid-peripheral cornea postoperatively, which impaired the corneal optical performance in ray-tracing analysis.

Conclusions

Lamellar keratotomy effectively reduced high preoperative astigmatism in cataract surgery. This surgical approach was combined with a superior, temporal, or oblique corneal incision.

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References

  1. Akura J, Matsuura K, Hatta S, Otsuka K, Kaneda S (2000) A new concept for the correction of astigmatism: full-arc, depth-dependent astigmatic keratotomy. Ophthalmology 107:95–104

    Article  CAS  PubMed  Google Scholar 

  2. Anders N, Pham DT, Linke C, Wollensak J (1996) Bogenförmige lamellierende Keratotomie zur Astigmatismuskorrektur. Ophthalmologe 93:279–283

    CAS  PubMed  Google Scholar 

  3. Anders N, Pham DT, Huebscher HJ, Linke C, Wollensak J (1997) Correcting postoperative astigmatism using curved lamellating keratotomy. J Cataract Refract Surg 23:196–201

    CAS  PubMed  Google Scholar 

  4. Anders N, Pham DT, Antoni HJ, Wollensak J (1997) Postoperative astigmatism and relative strength of tunnel incisions: a prospective clinical trial. J Cataract Refract Surg 23:332–336

    CAS  PubMed  Google Scholar 

  5. Bogan SJ, Waring GO, Ibrahim O, Drews C, Curtis L (1990) Classification of normal corneal topography based on computer-assisted videokeratography. Arch Ophthalmol 108:945–949

    CAS  PubMed  Google Scholar 

  6. Camp JJ, Maguire LJ, Cameron BM, Robb RA (1990) A computer model for the evaluation of the effect of corneal topography on optical performance. Am J Ophthalmol 109:379–386

    CAS  PubMed  Google Scholar 

  7. Duffey RJ, Jain VN, Tchah H, Hofmann RF, Lindstrom RL (1988) Paired arcuate keratotomy—a surgical approach to mixed and myopic astigmatism. Arch Ophthalmol 106:1130–1135

    CAS  PubMed  Google Scholar 

  8. Greivenkamp JE, Schwiegerling J, Miller JM, Mellinger MD (1995) Visual acuity modeling using optical raytracing of schematic eyes. Am J Ophthalmol 120:227–240

    CAS  PubMed  Google Scholar 

  9. Holladay JT, Lynn MJ, Waring GO, Gemmill M, Keehn GC, Fielding B (1991) The relationship of visual acuity, refractive error, and pupil size after radial keratotomy. Arch Ophthalmol 109:70–76

    CAS  PubMed  Google Scholar 

  10. Jaffe NS (1981) Postoperative corneal astigmatism. In: Jaffe NS (ed) Cataract surgery and its complications. Mosby, St Louis, pp 92–110

    Google Scholar 

  11. Kohnen T, Dick B, Jacobi KW (1995) Comparison of the induced astigmatism after temporal clear corneal tunnel incisions of different sizes. J Cataract Refract Surg 21:417–424

    CAS  PubMed  Google Scholar 

  12. Maloney RK, Bogan SJ, Waring GO (1993) Determination of corneal image-forming properties from corneal topography. Am J Ophthalmol 115:31–41

    CAS  PubMed  Google Scholar 

  13. Merriam JC, Zheng L, Merriam JE, Zaider M, Lindström B (2003) The effect of incisions for cataract on corneal curvature. Ophthalmology 110:1807–1813

    Article  PubMed  Google Scholar 

  14. Newton RH, Meek KM (1998) Circumcorneal annulus of collagen fibrils in the human limbus. Invest Ophthalmol Vis Sci 39:1125–1134

    CAS  PubMed  Google Scholar 

  15. Nordwald K, Anders N, Walkow T, Pham DT (1999) Langfristige Stabilität der Astigmatismusänderung nach bogenförmiger lamellierender Keratotomie (BLK)—Dreijahresergebnisse einer prospektiven Studie. Ophthalmologe 96:453–458

    Article  CAS  PubMed  Google Scholar 

  16. Pham DT (1995) Kataraktchirurgie mit kontrolliertem Astigmatismus—Eine neue Herausforderung. In: Rochels R, Duncker GIW, Hartmann Ch (eds) Kongreß der Deutschsprachigen Gesellschaft für Intraokularlinsen-Implantation. Springer, Berlin Heidelberg New York Tokyo, pp 301–308

    Google Scholar 

  17. Pham DT, Scherer V, Wollensak J (1996) Sponge-Oberflächenanästhesie in der Kataraktchirurgie (bei skleralem Tunnelschnitt). Klin Monatsbl Augenheilkd 209:347–353

    CAS  PubMed  Google Scholar 

  18. Pham DT, Weller A, Pfeiffer S, Cieschinger W (1998) Schmerzempfindlichkeit nach intrakameraler Lidocain-Applikation versus Sponge-Anästhesie in der Katarakt-Chirurgie—Eine prospektive randomisierte Studie. Klin Monatsbl Augenheilkd 212:(Suppl.2)32

    PubMed  Google Scholar 

  19. Price FW, Grene RB, Marks RG, Gonzales JS et al (1995) Astigmatism reduction clinical trial: a multicenter prospective evaluation of the predictability of arcuate keratotomy. Arch Ophthalmol 113:277–282

    CAS  PubMed  Google Scholar 

  20. Rabinowitz YS, Yang H, Brickman Y, Akkina J, Riley C, Rotter JI, Elashoff J (1996) Videokeratography database of normal human corneas. Br J Ophthalmol 80:610–616

    CAS  PubMed  Google Scholar 

  21. Rowsey JJ (1983) Ten caveats in keratorefractive surgery. Ophthalmology 90:148–155

    CAS  PubMed  Google Scholar 

  22. Smolek MK (1993) Interlamellar cohesive strength in the vertical meridian of human eye bank corneas. Invest Ophthalmol Vis Sci 34:2962–2969

    CAS  PubMed  Google Scholar 

  23. Swinger CA (1987) Postoperative astigmatism. Surv Ophthalmol 31:219–248

    Article  CAS  PubMed  Google Scholar 

  24. Wang L, Misra M, Koch DD (2003) Peripheral corneal relaxing incisions combined with cataract surgery. J Cataract Refract Surg 29:712–722

    Article  CAS  PubMed  Google Scholar 

  25. Wirbelauer C, Anders N, Pham DT, Wollensak J (1997) Effect of incision location on preoperative oblique astigmatism after scleral tunnel incision. J Cataract Refract Surg 23:365–371

    CAS  PubMed  Google Scholar 

  26. Wirbelauer C, Scholz C, Hoerauf H, Pham DT, Laqua H, Birngruber R (2002) Non-contact corneal pachymetry with slitlamp-adapted optical coherence tomography. Am J Ophthalmol 133:444–450

    Article  PubMed  Google Scholar 

  27. Woo SJ, Lee JH (2003) Effect of central corneal thickness on surgically induced astigmatism in cataract surgery. J Cataract Refract Surg 29:2401–2406

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors have no commercial, proprietary, or financial interest in any research or devices described in the presented study.

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Correspondence to Christopher Wirbelauer.

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Wirbelauer, C., Böhm, T., Häberle, H. et al. Lamellar keratotomy to correct astigmatism in cataract surgery. Graefe's Arch Clin Exp Ophthalmol 243, 243–249 (2005). https://doi.org/10.1007/s00417-004-0968-x

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  • DOI: https://doi.org/10.1007/s00417-004-0968-x

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