Refractive changes after phacoemulsification combined with deep sclerectomy assisted by corneal topography

Abstract

Purpose: To evaluate the corneal surgically induced refractive change (SIRC) after phacoemulsification and deep sclerectomy.

Setting: Glaucoma Unit, Department of Ophthalmology, Hospital Ramon y Cajal, Madrid, Spain.

Methods: This prospective study comprised 38 eyes of 35 patients with a mean age of 77 years having phacoemulsification using a right clear corneal approach (temporal approach and nasal approach in the right eye and the left eye, respectively) combined with a deep sclerectomy and placement of a reticulated hyaluronic acid implant in the superior quadrant. Computerized keratography was performed preoperatively and 1 month and 3 months postoperatively. The SIRC was calculated at each follow-up by the Holladay-Cravy-Koch method and was expressed vectorially in 3 Cartesian coordinates to facilitate statistical analysis.

Results: The magnitude of the resulting mean SIRC components was very small. No significant change was observed in any vectorial component 1 month and 3 months postoperatively. Overall, 47.4% of patients had an induced with-the-rule astigmatism change at 3 months (range 0.03 to 1.67 diopters [D]); however, the mean change was less than 0.50 D and not statistically significant. The mean spherical postoperative change was greater in left eyes than in right eyes (P = .05). No statistically significant changes between the right eye and left eye were observed in the astigmatism vectorial components.

Conclusions: Overall, the refractive change after phacoemulsification combined with deep sclerectomy was mild and not clinically significant. The greater mean spherical change in left eyes than in right eyes might be related to the phacoemulsification approach.