Astigmatism following cataract surgery: comparison of a scleral and a corneal incision in a mixed group of patients with and without glaucoma.

We retrospectively analysed the course of postoperative corneal astigmatism and corrected visual acuity after extracapsular cataract extraction and posterior chamber lens implantation with either a corneal or a scleral incision in 170 eyes of 155 patients with and without glaucoma. A continuous 10/0 nylon shoelace suture was used for wound closure in two groups. In a third group, corneal wound closure was performed with a shorter shoelace suture in combination with two vicryl wing sutures at 11 and 1 o'clock. Although early postoperative mean astigmatism in eyes operated through a corneal incision was high (range 2.92-6.67 diopters at 1 month postoperatively) and significantly different when compared to eyes operated through a scleral incision (1.96 diopters), final mean astigmatism did not differ significantly between those two groups. Moreover, in 27% of eyes operated through a corneal incision, mean astigmatism at 2 months postoperatively was not significantly different from the scleral group and suture removal was not necessary. There was no statistically significant difference in corrected visual acuity over the entire study period between groups. Since safety and functional results of the corneal incision were not different from the scleral incision, we prefer a corneal incision in cataract surgery because of its surgical advantages, especially in patients with cataract and coexisting glaucoma.