A Comparative Study on Surgically Induced Astigmatism after Phacoemulsification and Its Correlation with the Central Corneal Thickness

Fitore Shoshi, Kelmend Spahiu, Flaka Shoshi

International Journal of Biomedicine. 2023;13(4):277-280.
DOI: 10.21103/Article13(4)_OA7
Originally published December 5, 2023


Background: Cataracts being a disease with a very high prevalence, have been treated with various surgical and conservative forms for centuries. The aim of our study was to determine the correlation between central corneal thickness (CCT) and post-operative astigmatism after phacoemulsification.
Methods and Results: This prospective, observational study was carried out in the Clinic of Ophthalmology at the University Clinical Center of Kosovo. The study included 101 eyes of patients who underwent cataract surgery with phacoemulsification for treatment and intra-ocular lens (IOL) implantation. Patients were divided into two groups, depending on the central thickness of the cornea. Group 1 included 29 patients who had CCT <550 µm and Group 2 included 72 patients who had CCT ≥550 µm.  The mean age of patients in Group 1 and Group 2 was 69.0±10.5 years and 70.1±10.8 years, respectively, without significant difference between groups. The right eye was affected in 54.6% of cases. The patients were followed up for the evaluation of postoperative astigmatism on Day 7, two weeks, and two months after the surgery. Astigmatism was lower in Group 2 than in Group 1 at all stages of the examination but without a statistically significant difference. We did not find significant correlations between the CCT and astigmatism after phacoemulsification.
Conclusion: Results of our study show no significant correlation between CCT and SIA after cataract surgery with phacoemulsification.

central corneal thickness • phacoemulsification • surgically induced astigmatism
  1. Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS. Cataracts. Lancet. 2017 Aug 5;390(10094):600-612. doi: 10.1016/S0140-6736(17)30544-5. Epub 2017 Feb 25. PMID: 28242111.
  2. Kohnen T. Refractive surgical problem. The Journal of Cataract & Refractive Surgery (JCRS). 1997 Jan 1;23(1):19-26.
  3. Guirao A, Redondo M, Artal P. Optical aberrations of the human cornea as a function of age. J Opt Soc Am A Opt Image Sci Vis. 2000 Oct;17(10):1697-702. doi: 10.1364/josaa.17.001697. PMID: 11028517.
  4. Gorovoy I. Two techniques for managing posterior polar cataracts: traditional phacoemulsification versus femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2015 Mar;41(3):696. doi: 10.1016/j.jcrs.2015.01.004. PMID: 25804600.
  5. Watson A, Sunderraj P. Comparison of small-incision phacoemulsification with standard extracapsular cataract surgery: post-operative astigmatism and visual recovery. Eye (Lond). 1992;6 ( Pt 6):626-9. doi: 10.1038/eye.1992.135. PMID: 1289142.
  6. Zheng L, Merriam JC, Zaider M. Astigmatism and visual recovery after 'large incision' extracapsular cataract surgery and 'small' incisions for phakoemulsification. Trans Am Ophthalmol Soc. 1997;95:387-410; discussion 410-5. PMID: 9440181; PMCID: PMC1298369.
  7. Zhang JY, Feng YF, Cai JQ. Phacoemulsification versus manual small-incision cataract surgery for age-related cataract: meta-analysis of randomized controlled trials. Clin Exp Ophthalmol. 2013 May-Jun;41(4):379-86. doi: 10.1111/j.1442-9071.2012.02868.x. Epub 2013 Feb 4. PMID: 22958062.
  8. Ermiş SS, Inan UU, Oztürk F. Surgically induced astigmatism after superotemporal and superonasal clear corneal incisions in phacoemulsification. J Cataract Refract Surg. 2004 Jun;30(6):1316-9. doi: 10.1016/j.jcrs.2003.11.034. PMID: 15177610.
  9. Kohnen T, Dick B, Jacobi KW. Comparison of the induced astigmatism after temporal clear corneal tunnel incisions of different sizes. J Cataract Refract Surg. 1995 Jul;21(4):417-24. doi: 10.1016/s0886-3350(13)80532-9. PMID: 8523286.
  10. Vasavada V, Vasavada V, Raj SM, Vasavada AR. Intraoperative performance and postoperative outcomes of microcoaxial phacoemulsification. Observational study. J Cataract Refract Surg. 2007 Jun;33(6):1019-24. doi: 10.1016/j.jcrs.2007.02.029. PMID: 17531697.
  11. Alió J, Rodríguez-Prats JL, Galal A, Ramzy M. Outcomes of microincision cataract surgery versus coaxial phacoemulsification. Ophthalmology. 2005 Nov;112(11):1997-2003. doi: 10.1016/j.ophtha.2005.06.024. Epub 2005 Sep 23. PMID: 16183129.
  12. Masket S, Wang L, Belani S. Induced astigmatism with 2.2- and 3.0-mm coaxial phacoemulsification incisions. J Refract Surg. 2009 Jan;25(1):21-4. doi: 10.3928/1081597X-20090101-04. PMID: 19244949.
  13. Loriaut P, Kaswin G, Rousseau A, Meziani L, M'nafek N, Pogorzalek N, Labetoulle M. Évolution de l'astigmatisme après ablation d'une suture cornéenne pour chirurgie de la cataracte [Induced astigmatism after corneal suture removal after cataract surgery]. J Fr Ophtalmol. 2014 Mar;37(3):226-30. French. doi: 10.1016/j.jfo.2013.09.005. Epub 2014 Feb 18. PMID: 24559514.
  14. Kim YK, Kim YW, Woo SJ, Park KH. Comparison of surgically-induced astigmatism after combined phacoemulsification and 23-gauge vitrectomy: 2.2-mm vs. 2.75-mm cataract surgery. Korean J Ophthalmol. 2014 Apr;28(2):130-7. doi: 10.3341/kjo.2014.28.2.130. Epub 2014 Mar 14. PMID: 24688255; PMCID: PMC3958628.
  15. Watanabe A, Shibata T, Takashina H, Ogawa S, Tsuneoka H. Changes in corneal thickness following vitreous surgery. Clin Ophthalmol. 2012;6:1293-6. doi: 10.2147/OPTH.S33421. Epub 2012 Aug 10. PMID: 22927742; PMCID: PMC3422148.
  16. Woo SJ, Lee JH. Effect of central corneal thickness on surgically induced astigmatism in cataract surgery. J Cataract Refract Surg. 2003 Dec;29(12):2401-6. doi: 10.1016/s0886-3350(03)00254-2. PMID: 14709304.

Download Article
Received October 20, 2023.
Accepted December 2, 2023.
©2023 International Medical Research and Development Corporation.