Irregular astigmatism after cataract surgery resulting from inadequate clear corneal incision formation.

A 66-year-old woman was referred to us due to visual complaints after cataract surgery. The patient's complaints were decreased visual acuity and a localized blur in her visual field. At slit lamp biomicroscopy, an unusually long and centrally located clear corneal incision was noted. Corneal topography revealed an irregular astigmatism in the optical axis, originating from the site of the incision. The patient's visual complaints were treated by fitting a rigid gas permeable contact lens, which increased her best corrected visual acuity to 20/16. This case report demonstrated that inadvertently long and centrally located corneal incisions should be avoided during cataract surgery to prevent high levels of irregular astigmatism. RGP contact lenses can lead to successful visual rehabilitation.

[1]  D. Pham,et al.  Lamellar keratotomy to correct astigmatism in cataract surgery , 2005, Graefe's Archive for Clinical and Experimental Ophthalmology.

[2]  D. Charpentier,et al.  Refractive results of radial keratotomy after 10 years. , 1998, Journal of refractive surgery.

[3]  J. Gottsch,et al.  Contact lenses for visual rehabilitation after corneal laceration repair. , 1989, Ophthalmology.

[4]  W. Smiddy,et al.  Keratoconus: Contact Lens or Keratoplasty? , 1988 .

[5]  S. Tseng,et al.  Comparison of surgically induced astigmatism after sutureless temporal clear corneal and scleral frown incisions , 1998, Journal of cataract and refractive surgery.

[6]  G. Rao,et al.  Management of pellucid marginal corneal degeneration with rigid gas permeable contact lenses. , 2002, The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc.

[7]  J. Alió,et al.  Contact lens fitting to correct irregular astigmatism after corneal refractive surgery , 2002, Journal of cataract and refractive surgery.

[8]  K. Zadnik,et al.  Fitting gas-permeable contact lenses after penetrating keratoplasty. , 1985, American journal of ophthalmology.

[9]  A. Nizam,et al.  Morning-to-evening change in refraction, corneal curvature, and visual acuity 11 years after radial keratotomy in the prospective evaluation of radial keratotomy study. The PERK Study Group. , 1996, Ophthalmology.

[10]  P. Binder.  Optical problems following refractive surgery. , 1986, Ophthalmology.

[11]  R. Nuijts,et al.  Rigid gas-permeable contact lens fitting in LASIK patients for the correction of multifocal corneas , 2001, Graefe's Archive for Clinical and Experimental Ophthalmology.

[12]  J. Alió,et al.  Advances in microincision cataract surgery intraocular lenses , 2006, Current opinion in ophthalmology.

[13]  S. Harding,et al.  Corneoscleral burn during phacoemulsification surgery , 1998, Journal of cataract and refractive surgery.

[14]  D. Azar,et al.  Astigmatism outcomes of horizontal temporal versus nasal clear corneal incision cataract surgery , 2004, Journal of cataract and refractive surgery.

[15]  Clinical evaluation of the arched blade for cataract surgery. , 2005, Acta ophthalmologica Scandinavica.

[16]  R. Schertzer,et al.  Clinical course of phacoemulsification wound burns. , 1999, Journal of cataract and refractive surgery.

[17]  Ke Yao,et al.  Corneal astigmatism, high order aberrations, and optical quality after cataract surgery: microincision versus small incision. , 2006, Journal of refractive surgery.

[18]  J. Murube,et al.  Choosing the location of corneal incision based on preexisting astigmatism in phacoemulsification. , 2005, American journal of ophthalmology.

[19]  A. E. Murchison,et al.  Enlargement of the temporal clear corneal cataract incision to treat pre-existing astigmatism. , 2002, Journal of refractive surgery.

[20]  T. Kohnen,et al.  Effect of temporal and nasal unsutured limbal tunnel incisions on induced astigmatism after phacoemulsification , 2002, Journal of cataract and refractive surgery.

[21]  T. Kohnen,et al.  Comparison of the induced astigmatism after temporal clear corneal tunnel incisions of different sizes , 1995, Journal of cataract and refractive surgery.

[22]  P. McDonnell,et al.  Results of the prospective evaluation of radial keratotomy (PERK) study 10 years after surgery. , 1994, Archives of ophthalmology.

[23]  J. Alió,et al.  Contact lens fitting in keratoconus. , 2006, Comprehensive ophthalmology update.

[24]  Robert W. Thompson,et al.  Incisional refractive surgery , 2002, Current opinion in ophthalmology.

[25]  G. Waring,et al.  Complications of radial and transverse keratotomy. , 1989, Survey of ophthalmology.

[26]  M. Zaider,et al.  The effect of incisions for cataract on corneal curvature. , 2003, Ophthalmology.