Temporal versus superior approach phacoemulsification: Short-term postoperative astigmatism

Purpose: To compare short-term clinical, postoperative astigmatism, and uncorrected visual acuity results 2 months after no-stitch phacoemulsification using a temporal clear corneal approach and poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation through a 5.2 mm incision with those after no-stitch superior corneoscleral phacoemulsification. Setting: University Eye Clinic of Palermo, Italy. Methods: This prospective clinical trial comprised 80 patients with senile cataract who were randomly assigned to have phacoemulsification using a temporal approach or a superior approach. Surgically induced astigmatism (SIA) was calculated using Naeser's polar value method for determining with-the-rule (WTR) or against-the-rule (ATR) change. Results: There was a highly significant between-group difference in SIA at each examination (P < .001; t-test) because of positive (WTR) SIA in the temporal approach group and negative (ATR) SIA in the superior approach group. No other significant differences between groups were found (P < .05, t-test). More patients in the temporal group had an uncorrected visual acuity of 20/25 or better 2 weeks postoperatively, although the difference between groups was not statistically significant (P = .562; chi-square). Conclusion: Phacoemulsification using a no-stitch, temporal, 5.2 mm clear corneal incision produced results comparable to those using a corneoscleral superior approach. A longer study of a larger series should be done to confirm the findings.