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31.05.2021 | original article Open Access

Surgically induced astigmatism and coupling effect-mediated keratometric changes after conventional phacoemulsification cataract surgery

Spektrum der Augenheilkunde
Reinhard Angermann, Christoph Palme, Philipp Segnitz, Andreas Dimmer, Eduard Schmid, Markus Hofer, Bernhard Steger
Wichtige Hinweise

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The aim of the present study was to describe surgically induced astigmatism (SIA) and the coupling effect after conventional phacoemulsification cataract surgery (CPS) in relation to the incisional axis.

Material and methods

A total of 42 patients were included in the retrospective case series study. Corneal topography was obtained for patients with significant cataract before and 6 weeks after CPS with a main clear corneal incision size of 2.4 mm. Patients were grouped according to the relationship of the incisional axis to the position of the steep axis into a steep incisional group and a flat incisional group.


In total, 46 eyes were included in the study. While the steep incisional group showed an SIA of −0.15 D (± 0.35), the flat incisional group had a significantly higher SIA of 0.20 D (± 0.51) (p = 0.03). The coupling ratio (CR) in the steep incisional group was −0.38 (± 1.41) and in the flat incisional group it was 0.16 (± 0.97). Correspondingly, a coupling constant (CC) of −0.25 was found for group 1 and a CC of 0.0 for group 2.


Our results suggest that the location of the main incision should be decided with consideration of the corneal astigmatism in order to minimize the SIA. The CR helps to understand the effect of induced astigmatism and the change in spherical equivalent.

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