PROSPECTIVE, RANDOMIZED VECTOR ANALYSIS OF ASTIGMATISM AFTER 3-SUTURE, ONE-SUTURE, AND NO-SUTURE PHACOEMULSIFICATION

Purpose: To compare surgically induced astigmatism and visual outcomes after three-, one-, and no-suture phacoemulsification. Setting: Johns Hopkins Hospital, Baltimore, Maryland, and Manhattan Eye, Ear, and Th roat Hospital, New York, New York, USA. Methods: This prospective, ran domized study followed 131 patients treated with phacoemulsification w ith a 5.5 mm self-sealing scleral tunnel and implantation of a 5.5 mm poly(methyl methacrylate) posterior chamber lens. Radial 10-0 nylon su tures were used in the three- and one-suture groups. Results: Mean ast igmatism was greatest in the first postoperative week in ail groups an d stabilized after 8 weeks. The percentage of patients with with-the-r ule (WTR) astigmatism increased from baseline in the one- and three-su ture groups and decreased in the sutureless group. Mean uncorrected Sn ellen acuity was significantly better in the no- and one-suture groups than in the three-suture group at 1 week. There were no significant d ifferences in uncorrected acuity at other times. No statistically sign ificant differences in the surgically induced spherical equivalent wer e noted among the three groups during the 1 year follow-up. There was significantly less surgically induced keratometric astigmatism in the one-suture group at 4 (P = .03) and 8 (P = .007) weeks postoperatively . At. all follow-ups, the sutureless group had the greatest proportion of patients with significant ATR astigmatic shift (1 week, 17%; 4 wee ks, 32%), and the lowest proportion of patients with significant WTR a stigmatic shift (10% after 1 week). At 4 weeks, the percentage of pati ents with significant WTR shift in the one-suture group dropped to tha t in the sutureless group (10%); however, those in the one-suture grou p had less ATR astigmatic shift (16%). Conclusion: Sutureless and one- suture surgery resulted in a low percentage of WTR induced astigmatism 4 weeks postoperatively. Compared with sutureless surgery, the one-su ture surgery resulted in less ATR shift.