Shifting the Phaco Incision to treat Astigmatism

shifting phaco incision 134 title

Our phaco incisions always have some degree of astigmatic effect by causing relaxation of the corneal curvature at that axis. We can use this to our advantage to treat pre-existing corneal astigmatism at the time of cataract surgery. We can even increase the astigmatic effect by making a paired additional incision on the opposite site of the same axis. If the steep axis is at or near 180 degrees, then it is relatively easy for a surgeon who operates temporally to shift the main incision to that axis. But what about when the axis is steep at 90 degrees? We have shown that the surgeon can then sit at the head of the operating room table and then operate from the superior position.

This also applies for other axes such as this patient where the incision is made at 60 degrees in order to decrease the astigmatism. It is then coupled with a paired full-thickness incision on the opposite side of the cornea to provide more astigmatic benefit. This may require the surgeon to adjust the position of the patient’s head, the microscope, the foot-pedals, and even the speculum in order to provide adequate access for the surgery.

Pre-Op Measurements:
Refraction:  +2.00 +1.25 x 60   and Keratometry: 44.00 x 150 / 45.50 x 60

Post-Op Measurements:
Refraction: -0.25 +0.25 x 60    and Keratometry: 44.75 x 150 / 44.75 x 60

Click below to watch this video where we operate at the 60 degree axis:

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

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