To evaluate the effect of clear corneal incisional size on astigmatism during cataract surgery.

Randomized prospective study of 78 patients (108 eyes) who had received cataract surgery for a corneal astigmatism over against-the-rule (ATR) 1.0 Diopter (D) was performed. The eyes were checked by corneal topography and autorefractor preoperatively and one week, one month, two months, and six months postoperative. Group 1 included patients who received an inserted foldable intraocular lens (IOL) through a 2.8 mm incision, and Group 2 included patients who underwent IOL implantation through a corneal incision enlarged to 4 mm.

Postoperative visual acuity showed a better visual acuity in Group 2 at both one week postoperatively (0.598±0.352 vs., 0.713±0.345, for Groups 1 and 2, respectively, p =0.046) and one month postoperatively (0.604±0.237 vs., 0.791±0.242, respectively, p =.043). There were no statistically significant differences between the groups after two and six months ( p =.135, .087). Postoperative astigmatism measured by corneal topopgraphy showed 1.62±0.44D and, 0.94±0.30D for groups 1 and 2 respectively, ( P =.045) at 2 months, and 1.73±0.45 D and, 0.92±0.34 D ( P =.042) at six months. These results showed a statistically significant amount of residual astigmatism in Group 2. Autorefractor measurements showed similar results. There were no complications, such as wound leakage, resulting from the increased incision size.

Widening of the incision during cataract surgery can reduce corneal astigmatism without significant complications.