Early results of 500 cases of no-stitch cataract surgery.

My first 500 cases of no-stitch cataract surgery were evaluated in a randomized prospective study to compare the results of a 4.0 mm incision (foldable intraocular lens [IOL]) and a 5.2 mm incision (poly[methyl methacrylate] [PMMA] IOL). An additional group of 7.0 mm incision (PMMA IOL) no-stitch cases were studied retrospectively. One-day postoperative intraocular pressure averaged 20 mm Hg for both the 4.0 mm and 5.2 mm incision groups and 23 mm Hg for the 7.0 mm incision group. Hyphema occurred in 5% of the 4.0 mm incision group, in 1% of the 5.2 mm incision group, and in 5% of the 7.0 mm incision group. Surgically induced astigmatism, as absolute change in cylinder (without regard to axis) at three months postoperatively averaged 0.46 diopter (D) for the 4.0 mm incision group, 0.57 D for the 5.2 mm incision group, and 0.52 D for the 7.0 mm incision group. A prospective comparison of cold versus warm (room temperature) balanced salt solution irrigation during phacoemulsification demonstrated no statistically significant difference in effect on either the hyphema rate or astigmatism. However, the effect of scleral cautery on astigmatism, comparing cautery completely to the limbus with cautery only posterior to the insertion of Tenon's fascia, demonstrated a significant difference: an average of 50% reduction in the one week postoperative induced astigmatism was observed when the cautery was not carried all the way to the limbus. At three months, a 20% difference was still present.(ABSTRACT TRUNCATED AT 250 WORDS)