COMPARISON OF ASTIGMATISM FOLLOWING NUCLEUS MANAGEMENT BY PHACOFRACTURE AND SANDWICH TECHNIQUE BASED ON INCISION SIZE IN MANUAL SMALL INCISION CATARACT SURGERY

Abstract

Background: Astigmatism is a common refractive error that significantly affects visual outcomes after cataract surgery. This study examines the impact of two different nucleus management techniques, phacofracture and sandwich, on postoperative astigmatism, with a focus on incision size. Methods: A retrospective analysis of 200 cataract surgery patients was conducted. Patients were divided based on the surgical technique used—phacofracture or sandwich. The primary outcome was the degree of postoperative astigmatism, measured one month after surgery. Incision sizes were classified as small(<5mm) or large(>5mm), and their relationship with postoperative astigmatism was analyzed using odds ratios and chi-square tests for statistical significance. Results: The phacofracture technique with small incisions resulted in lower postoperative astigmatism rates (10%) compared to the sandwich technique with large incisions (40%) (p=0.002). The odds of developing higher degrees of astigmatism (>0.50 diopters) were significantly greater in the sandwich group compared to the phacofracture group with small incisions (OR=3.00, 95% CI: 1.58-5.70, p=0.001). Conclusion: The phacofracture technique, particularly with smaller incisions, significantly reduces postoperative astigmatism compared to the sandwich technique. The results emphasize the importance of incision size in minimizing refractive errors following cataract surgery.