Changes in astigmatism after congenital cataract surgery and intraocular lens implantation - A comparative study

Objective: To evaluate the postoperative changes in astigmatism in the pseudophakic eyes of children who underwent 1 of 3 different types of surgical incisions for congenital cataract extraction with intraocular lens implantation, and in whom astigmatism of at least 3 diopters (D) was recorded 1 week after the operation. Methods: We retrospectively reviewed the medical records of all the children in our department who had undergone surgery for nontraumatic cataract between 1992 and 2001. Cataract surgery with intraocular lens implantation was performed using 1 of 3 types of surgical incisions: a limbal incision, a scleral tunnel, or a clear corneal incision allowing the use of a foldable intraocular lens. In 28 children (32 eyes) aged 2 months to 11 years (mean+/-SD, 4.7+/-3.4 years), astigmatism of 3 D or more was found when assessed 1 week after surgery. The refraction was measured and recorded again 3 months and 5 months after surgery. The paired t test was used to compare the outcome variables. Main Outcome Measures: Refractive error 1 week, 3 months, and 5 months after surgery. Results: Mean+/-SD astigmatism 1 week postoperatively was 5.8+/-2.2 D, 5.1+/-2.1 D, and 4.0+/-1.3 D in groups 1, 2, and 3, respectively. Thereafter, the astigmatic component of the refractive error underwent a spontaneous decline, reaching mean+/-SD values of 0.9+/-1.0 D, 1.6+/-1.6 D, and 1.0+/-0.8 D, respectively, in the 3 groups 5 months after the operation. The difference between the mean values at 1 week and at 5 months in each group was statistically significant (P<.001 in group 1; P=.01 in group 2; and P<.001 in group 3). Conclusion: Children who underwent extraction of congenital cataract and intraocular lens implantation by different surgical techniques showed a significant spontaneous reduction in astigmatism postoperatively.