Effect of centration and circularity of manual capsulorrhexis on cataract surgery refractive outcomes.

PURPOSE

To determine if postoperative refractive outcome in cataract surgery relates to centration or circularity of the capsulorrhexis.

DESIGN

Prospective, observational study.

PARTICIPANTS

One hundred thirteen eyes from 108 patients undergoing routine phacoemulsification cataract surgery with manual continuous curvilinear capsulorrhexis.

METHODS

Patients underwent refraction, and digital retroillumination photographs were obtained 1 month and 1 year after surgery. Capsulorrhexis parameters were analyzed using computer photographic software.

MAIN OUTCOME MEASURES

Postoperative spherical equivalent (SE), deviation from predicted refraction, and postoperative spectacle cylinder.

RESULTS

At 1 month, mean capsulorrhexis circularity index was 0.83 ± 0.01 mm and mean decentration was 0.30 ± 0.14 mm. There was no significant correlation between either circularity or decentration and any of the refractive outcomes of SE, deviation from predicted refraction, or spectacle cylinder at 1 month or at 1 year. In contrast, an association between capsulorrhexis decentration and change in postoperative SE from 1 month to 1 year was observed: 56% of patients with more than 0.4 mm of decentration had a change in SE of more than 0.25 diopter (D) compared with 30% with 0.4 mm or less of decentration (P = 0.04). In eyes with incomplete capsulorrhexis-optic overlap, 60% had a change in spectacle cylinder of more than 0.50 D from 1 month to 1 year, compared with 15% of eyes with complete overlap (P = 0.004).

CONCLUSIONS

Postoperative refraction at 1 year was not related to centration or circularity of the capsulorrhexis. However, decentration by more than 0.4 mm was associated with a 0.25-D change in SE and incomplete capsulorrhexis-optic overlap was associated with a 0.50-D change in spectacle cylinder from 1 month to 1 year.