Comparative Study to Assess the Changes of Pre and Post Operative Keratometry Values in Patients Undergoing Small Incision Cataract Surgery

Abstract

Background:
Cataract remains the leading cause of reversible blindness worldwide. Manual Small Incision Cataract Surgery (MSICS) is widely performed, particularly in resource-limited settings, because of its affordability and effectiveness. However, surgically induced astigmatism (SIA) can adversely affect postoperative visual outcomes and is influenced by the location of the scleral incision.
Objective:
To compare the effects of superior and temporal scleral incisions on postoperative astigmatism and visual outcomes following MSICS.
Methods:
This prospective, randomized, single-blind study was conducted in the Department of Ophthalmology, VIMS Hospital, Ballari. Sixty patients with age-related cataract were randomly allocated into two groups: Group A (n=30) underwent MSICS with a superior scleral incision, while Group B (n=30) underwent MSICS with a temporal scleral incision. Patients with corneal pathology, glaucoma, retinal disease, previous refractive surgery, traumatic or complicated cataracts, and significant systemic disorders were excluded. Preoperative and postoperative keratometric measurements were obtained to assess the magnitude and axis of astigmatism, and postoperative visual acuity was evaluated.
Results:
Temporal scleral incisions produced significantly lower mean SIA than superior incisions (0.47 ± 0.21 D vs. 1.25 ± 0.42 D). Patients in the temporal incision group achieved better postoperative visual acuity, faster visual recovery, and greater refractive stability. The incision site was a significant determinant of postoperative astigmatism and visual outcomes.
Conclusion:
Temporal scleral incisions in MSICS significantly reduce surgically induced astigmatism compared with superior incisions, resulting in improved refractive outcomes and faster visual rehabilitation. As a simple, effective, and cost-efficient modification of surgical technique, the temporal approach should be considered the preferred incision site for optimizing visual outcomes following MSICS.