Long-Term Change in Corneal Astigmatism After Sutureless Cataract Surgery KEN HAYASHI, AKIRA HIRATA, SHIN-ICHI MANABE, AND HIDEYUKI HAYASHI ● PURPOSE: To compare long-term change in corneal astigmatism with advancing age between eyes that under- went sutureless cataract surgery and those that did not undergo surgery. ● DESIGN: Case-control study. ● METHODS: A total of 153 eyes that underwent phaco- emulsification with a horizontal incision more than 11 years ago (surgery group) and 153 age-matched control eyes that did not undergo surgery (nonsurgery group) were enrolled. The keratometric cylinder at baseline (at 1 year or more postoperatively in the surgery group) and at 5 and 10 years after baseline was examined. The corneal astigmatic change, as calculated using polar value analysis and vector decomposition analysis, between baseline and 5 years after baseline and between 5 and 10 years was compared between the groups. ● RESULTS: The mean corneal astigmatic change, specif- ically KP (90) in the polar analysis and against-the-rule component in the vector analysis, between baseline and 5 years and between 5 and 10 years showed an against-the- rule change in both groups. Using multivariate analysis, no significant difference was found in the corneal astig- matic change between the 2 groups at either time interval (P > .126). Furthermore, the change between baseline and 5 years was similar to that between 5 and 10 years in both groups (P > .315). ● CONCLUSIONS: Corneal astigmatism after sutureless cataract surgery shows a long-term against-the-rule change with advancing age, and this change is similar to that of normal cornea, suggesting that the against-the- rule change that occurs subsequently should be taken into consideration at the time of cataract surgery. (Am J Ophthalmol 2011;151:858 – 865. © 2011 by Elsevier Inc. All rights reserved.) A DVANCES IN SURGICAL TECHNIQUES AND DEVICES, including the toric intraocular lens (IOL), 1–5 a limbal relaxing incision, 6–8 or an opposite clear corneal incision, 9 –12 have enabled us to correct preopera- tive astigmatism during cataract surgery. On the other hand, it is well known that corneal astigmatism of healthy subjects generally changes from with-the-rule astigmatism to against-the-rule astigmatism with aging. 13–18 Accordingly, surgeons should take into consideration how the corneal astigmatism may continue to change subsequent to stabiliza- tion of any surgically induced change when they correct astigmatism at the time of cataract surgery. For instance, it remains unclear as to whether or not a small amount of with-the-rule astigmatism in young and middle-aged patients should be fully corrected, since the astigmatism may shift to an against-the-rule orientation with passing time. It has been shown that a surgically induced change in corneal astigmatism after unsutured cataract surgery shows an against-the-wound change. 19 –22 Accordingly, an against-the-rule shift occurs when the wound is made superiorly, while a with-the-rule shift occurs when the wound is made horizontally. A number of studies have shown that the surgically induced change in corneal astigmatism stabilizes within a year after surgery. 23–26 In contrast, long-term studies described by Rainer and asso- ciates 27,28 and by Drews 29 showed that the against-the-rule astigmatic shift continued for up to 5 years after sutureless cataract surgery. However, since the incisions were made at the 12-o’clock meridian, it is unclear whether the against-the-rule shift shown in those studies was attribut- able to the surgery or to aging. The purpose of the study described herein was to examine whether or not corneal astigmatism continues to change subsequent to stabilization of the surgically induced change resulting from sutureless cataract surgery. Furthermore, when corneal astigmatism continued to change, we attempted to investigate whether or not the long-term change in corneal astigmatism was different from the aging change of healthy corneas that did not undergo any surgery. To exclude the influence of surgically induced against-the-rule astigmatic shift, only eyes that underwent sutureless cataract surgery with a horizontal incision were enrolled in this study. In addition, to properly compare the vector change in corneal astigmatism shown in 2 variables, multivariate analysis was used for statistical comparison. 30,31 METHODS ● PATIENTS: The medical records of all patients who had undergone sutureless cataract surgery with implantation of a foldable IOL at the Hayashi Eye Hospital between Accepted for publication Nov 9, 2010. From the Hayashi Eye Hospital, Fukuoka, Japan (K.H., S.M.); Depart- ment of Ophthalmology, Saga University Faculty of Medicine, Saga, Japan (A.H.); and Department of Ophthalmology, School of Medicine, Fukuoka University, Fukuoka, Japan (H.H.). Inquiries to Ken Hayashi, Hayashi Eye Hospital, 4-23-35 Hakataeki- mae, Hakata-Ku, Fukuoka 812-0011, Japan; e-mail: hayashi-ken@ hayashi.or.jp © 2011 BY ELSEVIER INC.ALL RIGHTS RESERVED. 858 0002-9394/$36.00 doi:10.1016/j.ajo.2010.11.014