Long-term evolution of astigmatism following planned extracapsular cataract extraction

Area of Science:

• Ophthalmology
• Surgical Outcomes
• Corneal Physiology

Background:

• Extracapsular cataract extraction (ECCE) with suture closure is a common procedure.
• Postoperative astigmatism is a frequent complication influencing visual outcomes.
• Understanding long-term astigmatic changes is crucial for surgical planning and patient satisfaction.

Purpose of the Study:

• To investigate the long-term evolution of postoperative astigmatism following ECCE with interrupted 10-0 nylon suture closure.
• To determine if astigmatism stabilizes three months postoperatively, a common assumption.
• To identify patterns of astigmatic shift and factors influencing them.

Main Methods:

• Prospective follow-up of 66 eyes from 66 patients for three years after ECCE.
• Astigmatism measurement initiated at three months postoperatively, after suture removal.
• Analysis of astigmatic changes over time and correlation with initial induced astigmatism and suture integrity.

Main Results:

• Induced astigmatism at three months was not stable, showing a mean shift of 0.69 diopters towards against-the-rule astigmatism over three years.
• Three distinct patterns of astigmatic evolution were observed.
• Consistent induction of with-the-rule astigmatism was not achieved, but permanent against-the-rule astigmatism could be induced.
• The number of intact sutures did not influence the long-term shift towards against-the-rule astigmatism.

Conclusions:

• Postoperative astigmatism following ECCE with nylon sutures exhibits a long-term trend towards against-the-rule shift, extending beyond three months.
• The assumption of stable postoperative astigmatism at three months is inaccurate.
• Evaluation of surgical techniques aimed at modifying astigmatism must account for this prolonged evolution of cataract wound healing.