Clinical Study Postoperative Corneal and Surgically Induced Astigmatism following Superior Approach Manual Small Incision Cataract Surgery in Patients with Preoperative Against-the-Rule Astigmatism Edmund Arthur, 1 Ahmed Abdul Sadik, 1 David Ben Kumah, 1 Eugene Appenteng Osae, 1 Felix Agyemang Mireku, 1 Frank Yeboah Asiedu, 2 and Reynolds Kwame Ablordeppey 1 1 Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana 2 Ruebsam Eye Clinic, St. Dominic’s Hospital, P.O. Box 59, Akwatia, Ghana Correspondence should be addressed to Edmund Arthur; arthur edmund@yahoo.com Received 8 October 2016; Revised 14 November 2016; Accepted 7 December 2016 Academic Editor: Terri L. Young Copyright © 2016 Edmund Arthur et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Te aim of the study was to report postoperative corneal and surgically induced astigmatism (SIA) in patients with preoperative against-the-rule (ATR) astigmatism who underwent superior approach manual small incision cataract surgery (MSICS). 58 eyes of 58 cataract patients with preoperative ATR astigmatism were involved in this study. All patients had operable cataracts and underwent superior approach MSICS. Keratometric () readings were taken prior to surgery and at 12 weeks afer surgery. Centroid values of SIA, preoperative astigmatism, and postoperative astigmatism were calculated using Cartesian coordinates based analysis. Wilcoxon signed rank test was used to compute statistical signifcance between mean preoperative and postoperative corneal astigmatism. Cohen’s  was used as efect size measure. Centroid values of 1.42 D × 179, 2.48 D × 0, and 1.07 D × 1 were recorded, respectively, for preoperative astigmatism, postoperative astigmatism, and SIA. Wilcoxon signed rank test indicated that mean ± SD postoperative corneal astigmatism (2.80 ± 1.40 D) was statistically signifcantly greater than preoperative corneal astigmatism (1.49 ± 1.34 D),  = −6.263,  < 0.0001. A high Cohen’s  of 1.32 was found. Our results suggest statistical and clinically signifcant greater postoperative corneal astigmatism than preoperative corneal astigmatism for ATR astigmatism cataract patients who underwent superior approach MSICS. 1. Introduction Cataract poses both a signifcant socioeconomic burden and a public health concern as it is the leading cause of blindness worldwide [1] and a major cause of visual disability throughout the African continent [2–5]. Te current treat- ment for cataract is surgery [6, 7] and while phacoemulsif- cation remains the more advanced and technically superior method of cataract surgery, manual small incision cataract surgery (MSICS) is the most popular surgical management option for cataracts in developing countries [8–11]. Tis is mainly because of the low cost, short surgical time, reduced dependence on technology, and equivalent visual outcome to phacoemulsifcation [8–11]. Te location, size, and shape of incisions used in MSICS infuence postoperative surgically induced astigmatism (SIA) [12–14]. Temporal approach has been reported to result in smaller SIA than superior approach [12]. Small incisions (6 mm) induced the smallest SIA when compared with me- dium (6.5 mm) and large (7 mm) incisions [13]. Te chevron shaped incision has also been reported to give minimal SIA when compared with straight and frown incisions [14]. Cor- neal or keratometric SIA is the vector diference between the preoperative corneal or keratometric astigmatism and the postoperative astigmatism [15]. With reference to the location of the incision, placing the incision on the steeper corneal meridian based on the pre- operative keratometric () reading has been recommended Hindawi Publishing Corporation Journal of Ophthalmology Volume 2016, Article ID 9489036, 7 pages http://dx.doi.org/10.1155/2016/9489036