Effect of centration and circularity of manual capsulorrhexis on cataract surgery refractive outcomes

PURPOSE: To determine if postoperative refractive outcome in cataract surgery relates to centration or circularity of the capsulorrhexis. DESIGN: Prospective, observational study. PARTICIPANTS: One hundred thirteen eyes from 108 patients undergoing routine phacoemulsification cataract surgery with manual continuous curvilinear capsulorrhexis. METHODS: Patients underwent refraction, and digital retroillumination photographs were obtained 1 month and 1 year after surgery. Capsulorrhexis parameters were analyzed using computer photographic software. MAIN OUTCOME MEASURES: Postoperative spherical equivalent (SE), deviation from predicted refraction, and postoperative spectacle cylinder. RESULTS: At 1 month, mean capsulorrhexis circularity index was 0.83?0.01 mm and mean decentration was 0.30?0.14 mm. There was no significant correlation between either circularity or decentration and any of the refractive outcomes of SE, deviation from predicted refraction, or spectacle cylinder at 1 month or at 1 year. In contrast, an association between capsulorrhexis decentration and change in postoperative SE from 1 month to 1 year was observed: 56 of patients with more than 0.4 mm of decentration had a change in SE of more than 0.25 diopter (D) compared with 30 with 0.4 mm or less of decentration (P = 0.04). In eyes with incomplete capsulorrhexis-optic overlap, 60 had a change in spectacle cylinder of more than 0.50 D from 1 month to 1 year, compared with 15 of eyes with complete overlap (P = 0.004). CONCLUSIONS: Postoperative refraction at 1 year was not related to centration or circularity of the capsulorrhexis. However, decentration by more than 0.4 mm was associated with a 0.25-D change in SE and incomplete capsulorrhexis-optic overlap was associated with a 0.50-D change in spectacle cylinder from 1 month to 1 year. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed