Objective: To determine surgically induced astigmatism (SIA) in Chevron (inverted V shape), frown, Boat shaped and straight incisions in manual small incision cataract surgery conducted in patients admitted in RIMS, Srikakulam.

Material and Methods: study was conducted in patients getting admitted for cataract surgery in Rajiv Gandhi Institute of medical Sciences, Srikakulam, Andhra Pradesh. 100 patients were randomly selected who are above 40 years of age and senile cataract. They were divided into 4 groups with 25 each in each group. All four groups underwent similar manual incision cataract surgery with carefully placed intraocular lenses. Only difference between 4 groups is the type of incision during the beginning of cataract surgery. Patients were compared 6 weeks post operatively for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and surgically induced astigmatism. The datas obtained were tabulated and analyzed statistically using paired and unpaired t test and chi square test using SPSS version 17 software.

Observation: In our study Chevron incision produced minimal astigmatism with maximum patients (48%) with astigmatism between 0.5-1D. Followed by (36%) in 0.6-1D. Frown and boat shaped incisions showed almost similar results. There was significantly small difference between them which was negligible. in Frown incision maximum patients (44%) had astigmatism 1.1-1.5D followed by(28%) 0.5-1D. in boat shaped incision maximum patients(36%) were seen in 1.1-1.5D followed by(28%) 0.5-1D. straight incision showed significantly higher astigmatism with maximum patients (40%) between 1.1-1.5D.

Conclusion: Chevron incision (inverted V incision) induced significantly less surgically induced astigmatism followed by frown incision and boat shaped incision. Straight incision caused maximum surgically induced astigmatism.

Keyword: surgically induced astigmatism, chevron incision, frown incision, boat shaped incision, straight incision, MSICS, comparitive study.

1. Zawar SV, Gogate P. Safety and efficacy of temporal manual smallincision cataract surgery in India. Eur J Ophthalmol 2011;21(6):748-753
2. Tabin G, Chen M, Espandar L. Cataract surgery for the developing world. Curr OpinOphthalmol2008;19(1):55-59
3. Ruit S, Tabin G, Chang D, Bajracharya L, Kline DC, Richheimer W, Shrestha M, Paudyal G. A prospective randomized clinical trial of phacoemulsification manual sutureless small-incision extra capsularcataract surgery in Nepal. Am J Ophthalmol 2007;143(1):32-38
4. Khanna R, Pujari S, Sangwan V. Cataract surgery in developing countries. Curr Opin Ophthalmol 2011;22(1):10-14
5. Pershing S, Kumar A. Phacoemulsification versus extracapsular cataractextraction: where do we stand? Curr Opin Ophthalmol 2011;22(1):37-42
6. Gogate P, Deshpande M, Nirmalan PK. Why do phacoemulsification? Manual small-incision cataract surgery is almost as effective, but less expensive. Ophthalmology 2007;114(5):965-968
7. Haripriya A, Chang DF, Reena M, Shekhar M. Complication rates of phacoemulsification and manual small-incision cataract surgery at Aravind Eye Hospital. J cataract refract surg2012;38 (8):1360-1369.
8. Gokhale NS, Sawhney S. Reduction in astigmatism in manual smallincision cataract surgery through change of incision site. Indian J Ophthalmol2005;53(3):201-203.
9. Reddy B, Raj A, Singh VP. Site of incision and corneal astigmatism in conventional SICS versus phacoemulsification. Ann Ophthalmol (Skokie) 2007;39(3):209-216
10. Ale JB. Surgically induced astigmatism of small incision cataractsurgery. Nepal J ophthalmol2012;4(2):343
11. Guan CY, Xiao TT. Astigmatism following small incision cataractextraction through superotemporal incision. Eye sci 2012;27(2):94-97.
12. Mallik VK, Kumar S, Kamboj R, Jain C, Jain K, Kumar S. Comparisonof astigmatism following manual small incision cataract surgery: superiorversus temporal approach. Nepal J Ophthalmol2012;4(1):54-58
13. Randeri JK, Desai RJ, Mehta FS, Billore OP, Gupta A, Kukadia G. Incision induced astigmatism-a comparative study of Chevron incision and Frown incision in SICS. AIOS Proceedings 2008
14. Jauhari N, Chopra D, Chaurasia RK, Agarwal A. Comparison ofsurgically induced astigmatism in various incisions in manual smallincision cataract surgery.Int J Ophthalmol 2014;7(6):1001-1004
15. Jha KN, Vats DP. Manual small incision cataract surgery: experience at a military hospital. : MJAFI 2006;62(3):212-215
16. Rohatgi J, Gupta VP, Sangma D. A prospective randomized comparativestudy of manual SICS using 6 mm frown versus 5 mm modified ChevronIncision. AIOS Proceedings 2008.
17. randomization was done through NCBI approved site graphpad.com/quickcals/randomize2/

Dr Rajkumar Patra

Senior Resident, Department of Ophthalmology,

RIMS, Srikakulam