Temporal vs Superior Phaco Incisions

superior vs temporal title
We chose a superior phaco incision in this patient in order to help address the pre-existing with-the-rule (WTR) astigmatism. The rhexis is created manually with forceps and without the use of a femtosecond laser. See the video below for full details.

[Click link below for full video] Some surgeons prefer to make a superior phaco incision while others prefer a temporal approach. Is there a substantial difference and what are the considerations when choosing where to make the crucial main incision for cataract surgery? For most patients I prefer a temporal phaco incision because it provides the easiest access to the anterior and posterior chambers even if the brow is prominent or the eyes are deep-set. Also the temporal limbus is farthest from the visual axis and thus the astigmatic effect of the phaco incision is the least. But what about patients who have a degree of with-the-rule (WTR) astigmatism which has a steep axis at or about 90 degrees?

sup vs temp phaco incision

A temporal phaco incision is farther from the visual axis than an identical incision placed at the superior position. As such, the superior incision will induce more corneal flattening and more astigmatic effect compared to like incisions placed temporally. We can use this to our advantage in patients who have pre-existing with-the-rule (WTR) astigmatism and a steep axis at or about 90 degrees.

The superior approach can be more difficult in patients with prominent brows and/or deep-set eyes. The temporal approach tends to offer better access in these types of patients. An advantage of the superior incision is that it is protected under the upper eyelid compared to temporal incisions which are more exposed.

In the case here, the patient has about 1 diopter of corneal astigmatism, steep at 105 degrees. We place our phaco incision at this axis and that will help neutralize the majority of the pre-existing astigmatism. We are careful to place our incision at the limbus, barely nicking the blood vessels, and with a tunnel length that avoids encroaching on the visual axis. Our patient is also highly myopic and we determined via www.IOLcalc.com that an IOL power of +7.0 D would give her a post-op result of about -0.25 spherical.

Click below to see the full video of this case:

All content is © 2018 Uday Devgan MD. All rights reserved,

6 Comments

    1. Can you sent a complete set of videos
      It is very helpful for our post graduate residents
      Prof dr Shri Kant
      Head vitreo Retina &LASER unit
      Institute of medical science
      BHU Varanasi
      INDIA

      1. Hello Prof dr Shri kant: please tell your post-graduate residents to visit this site CataractCoach.com and they can have free access to ALL of the videos and ALL of the articles!

  1. Can you sent a complete set of videos
    It is very helpful for our post graduate residents
    Prof dr Shri Kant
    Head vitreo Retina &LASER unit
    Institute of medical science
    BHU Varanasi
    INDIA

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