Effect of centration and circularity of manual capsulorrhexis on cataract surgery refractive outcomes

Abstract

Purpose: To determine if postoperative refractive outcome in cataract surgery relates to centration or circularity of the capsulorrhexis.

Design: Prospective, observational study.

Participants: One hundred thirteen eyes from 108 patients undergoing routine phacoemulsification cataract surgery with manual continuous curvilinear capsulorrhexis.

Methods: Patients underwent refraction, and digital retroillumination photographs were obtained 1 month and 1 year after surgery. Capsulorrhexis parameters were analyzed using computer photographic software.

Main outcome measures: Postoperative spherical equivalent (SE), deviation from predicted refraction, and postoperative spectacle cylinder.

Results: At 1 month, mean capsulorrhexis circularity index was 0.83 ± 0.01 mm and mean decentration was 0.30 ± 0.14 mm. There was no significant correlation between either circularity or decentration and any of the refractive outcomes of SE, deviation from predicted refraction, or spectacle cylinder at 1 month or at 1 year. In contrast, an association between capsulorrhexis decentration and change in postoperative SE from 1 month to 1 year was observed: 56% of patients with more than 0.4 mm of decentration had a change in SE of more than 0.25 diopter (D) compared with 30% with 0.4 mm or less of decentration (P = 0.04). In eyes with incomplete capsulorrhexis-optic overlap, 60% had a change in spectacle cylinder of more than 0.50 D from 1 month to 1 year, compared with 15% of eyes with complete overlap (P = 0.004).

Conclusions: Postoperative refraction at 1 year was not related to centration or circularity of the capsulorrhexis. However, decentration by more than 0.4 mm was associated with a 0.25-D change in SE and incomplete capsulorrhexis-optic overlap was associated with a 0.50-D change in spectacle cylinder from 1 month to 1 year.