• Ken Hayashi, Motoaki Yoshida, and Koichi Yoshimura.
• From Hayashi Eye Hospital, Fukuoka, Japan. Electronic address: hayashi-ken@hayashi.or.jp.
• J Cataract Refract Surg. 2014 Dec 1; 40 (12): 2050-6.

PurposeTo compare the effect of steepest-meridian clear corneal incisions (CCIs) for reducing preexisting corneal astigmatism between a meridian-marking method and a surgeon's-intuition method.SettingHayashi Eye Hospital, Fukuoka, Japan.DesignRandomized controlled trials.MethodsEyes scheduled for phacoemulsification were randomized to 1 of 2 groups: a 2.65 mm steepest-meridian CCI using the meridian-marking method or a 2.65 mm steepest-meridian CCI using the surgeon's intuition. Regular and irregular corneal astigmatism, surgically induced astigmatism (SIA) vector, refractive status, higher-order aberrations (HOAs), uncorrected (UDVA) and corrected (CDVA) distance visual acuities, and physical meridian misalignment of the steepest-meridian CCI measured using anterior segment optical coherence tomography were evaluated preoperatively and 1 month and 3 months postoperatively.ResultsThe mean meridian misalignment of the steepest-meridian CCIs was significantly smaller in the meridian-marking group (4.4 degrees ± 2.8 [SD]) than in the surgeon's-intuition group (8.6 ± 4.4 degrees) (P ≤.0001). Regular and irregular corneal astigmatism and corneal HOAs did not change significantly postoperatively in either group. No significant difference was found in regular or irregular corneal astigmatism, refractive cylinder, manifest spherical equivalent value, SIA, HOAs, UDVA, or CDVA between the meridian-marking group and the surgeon's-intuition group throughout the follow-up.ConclusionThe physical meridian misalignment of steepest-meridian CCI was significantly smaller with the meridian-marking method than with the surgeon's-intuition method; however, the effect of the difference was not large enough to decrease remaining astigmatism and HOAs or to improve the UDVA.Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

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