Purpose: To evaluate visual outcomes and surgically induced astigmatism (SIA) following manual small incision cataract surgery (MSICS) using three different scleral incision geometries: straight, frown, and chevron. Methods: In this prospective, randomized clinical trial, 150 patients with age-related cataracts were assigned to one of three incision groups (straight, frown, and chevron). All surgeries were performed by a single surgeon using a standardized technique. Visual acuity (VA) and keratometric readings were measured preoperatively and at multiple postoperative intervals, with the primary outcomes being the uncorrected and best-corrected VA (UCVA and BCVA) and SIA at 30 days. Statistical significance was set at P < 0.05. Results: There were 50 patients in each group. All the patients had preoperative VA <6/60. At postoperative day 30, UCVA ≥ 6/18 was achieved in 90% (straight), 88% (frown), and 92% (chevron) of patients ( P = 0.570), with BCVA ≥ 6/18 in over 98% across all groups ( P = 0.365). Mean SIA was lowest in the chevron group (0.90 ± 0.22 D) compared to the straight (1.10 ± 0.42 D) and frown (1.07 ± 0.37 D) groups, although this difference was not statistically significant ( P = 0.208). The chevron group also had the highest proportion of eyes with postoperative astigmatism <1 D (68%). Conclusion: All three scleral incision types in MSICS yielded excellent visual outcomes. However, the chevron incision demonstrated a trend toward less SIA, making it a potentially advantageous choice in resource-limited settings where postoperative optical correction may be challenging.
Nouhoum et al. (Wed,) studied this question.