Effect of superior and temporal clear corneal incisions on astigmatism after sutureless phacoemulsification

Purpose: To evaluate the effect of superior and temporal clear corneal incisions on astigmatism after sutureless, small incision phacoemulsification. Setting: World Eye Hospital, Istanbul, Turkey. Methods: This prospective study evaluated 40 eyes of 20 patients with cataract having bilateral, sutureless, small incision phacoemulsification by the same surgeon. A superior clear corneal incision was used in all right eyes and a temporal clear corneal incision in ail left eyes. Mean preoperative astigmatism was 0.63 diopter(D) +/- 0.21 (SD) and 0.65 +/- 0.20 D, respectively. Mean patient age was 66.45 years. Patients were examined preoperatively and 1 day, 1 week and 1 and 3 months postoperatively. Results: Three months postoperatively, mean astigmatism was 1.60 +/- 0.37 D in the superior incision group and 0.83 +/- 0.19 D in the temporal incision group. Induced astigmatism calculated by vector analysis was 1.44 +/- 0.31 D and 0.62 +/- 0.28 D, respectively. The temporal incision group had significantly lower astigmatism at all follow-ups (P = .000). Conclusion: Upper lid pressure on the superior corneal incisions led to fluctuating, against-the-rule astigmatism that was significantly higher than that induced by temporal incisions.