Changes in Corneal Higher Order Aberrations Following Cataract Surgery With Different Incision Sites: A Prospective, Randomized Study.

Purpose: To compare the effect of superior and temporal clear corneal incisions, regardless of the steep axis, on postoperative changes in corneal higher order aberrations (HOAs) in patients with healthy corneas and mild preoperative corneal astigmatism.

Methods: In this prospective cohort study, the right eyes of study participants were randomly assigned to one of two groups prior to cataract surgery: temporal incision (TI) and superior incision (SI). Preoperatively and 6 weeks after surgery, measurements were taken of corneal HOAs over a 6-mm optical zone.

Results: The study included 102 eyes (50 eyes in the TI group and 52 eyes in the SI group) that underwent routine phacoemulsification using a 2.4-mm clear corneal incision. Significant changes in vertical coma (P = .019), horizontal coma (P = .042), and vertical trefoil (P = .001) were observed in the SI group. In the subgroup analysis of the SI group, significant changes in vertical coma (P = .025) and vertical trefoil (P = .047) were observed in the eyes with preoperative with-the-rule corneal astigmatism, and significant changes in horizontal coma (P = .038) were observed in eyes with preoperative against-the-rule corneal astigmatism. The TI group showed no significant difference between the preoperative and postoperative periods.

Conclusions: The SI induced vertical and horizontal coma in accordance with the preoperative axis of the steep meridian. These alterations in corneal HOAs may affect the quality of vision after surgery. TI may potentially provide an advantage over SI in terms of corneal HOAs. [J Refract Surg. 2024;40(11):e792-e796.].