Five year study of astigmatic stability after cataract surgery with intraocular lens implantation: comparison of wound sizes.

PURPOSE: To assess the long-term stability of cataract wounds of various lengths.

SETTING

Private practice.

METHODS

This retrospective study comprised 5 groups of consecutive cataract surgery cases and 1 control group with similar mean ages and wound lengths of 10.0, 6.0, 4.0, 2.0, and 0 (control) mm. Except for the 4.0 mm cases, follow-up was 5 years, with few patients lost during that time. Cases within each group had the same wound position, configuration, and suturing. Refractive data, controlled by keratometry, were collected and analyzed preoperatively and 1 day, 1 and 6 weeks, 3 and 6 months, and 1, 2, 3, 4, and 5 years postoperatively. No sutures were cut.

RESULTS

With long-term follow-up, there was a progressive against-the-rule shift in astigmatism. Smaller wounds showed less immediate induced astigmatism. However, except for the unsutured 2.0 mm iridectomy wounds and the control group, all shifted similarly. Data were not available for the 4.0 mm wounds beyond 1 year.

CONCLUSION

Wounds were not necessarily "stable" at 6 months. Larger wounds continued to shift years after surgery. Smaller wounds have significant postoperative advantages, but absolute long-term refractive stability may not be one.