| Cataract is the No.1 eye disease in China at present t which causes blindness and has now been listed as the head of China's three recovered objects. As people's living standards improve, more and more demands on the eyesight increase. Visual quality has become increasingly important after cataract surgery. Among them, the impact of corneal astigmatism becomes a major factor in postoperative visual quality. How to control and correct astigmatism after cataract surgery has become hot issue to ophthalmologists. The traditional large incision extracapsular cataract extraction surgery often caused a surgically induced corneal astigmatism which had great impact on fuming effect. Phacoemulsification surgery can significantly reduce postoperative astigmatism, but because of the need of expensive equipment, that is difficult used in poor areas and the grass-roots hospitals. small incision non-phacoemul sification cataract extraction, which is simple, surgical safe, and cost less, has spread value. This study will investigate the effect of different types of incisions on the changes of postoperative astigmatism and corneal endothelium after small incision non-phacoemul sification cataract extraction combined with implantation of artificial lens.OBJECTIVETo study the effect of incisions with different distance from limbus and different shapes on the changes of postoperative astigmatism, SRI, SAI and corneal endothelium after small incision non-phacoemul sification cataract extraction combined with implantation of artificial lens. METHODS297 patients (297 eyes) with cataract were divided into three groups according to incisions with different distance from limbus: Group A (the distance is 1.5mm from incision to limbus), Group B (the distance is 2.0mm from incision to limbus), Group C (the distance is 2.5mm from incision to limbus). Each group was divided into two groups according to the incision shape: straight-line group (length is 6.0mm), anti-superciliary arch-shaped group (chord length is 6.0mm), So we obtained 6 sub-groups: Group A1 (straight-line incision with distance of 1.5mm from the limbus): 48 patients, Group A2 group (anti-superciliary arch-shaped incision with distance of 1.5mm from the limbus): 52 patients, Group B1 (straight-line incision with distance of 2.0 mm from the limbus): 48 patients, Group B2 (anti-superciliary arch-shaped incision with distance of 2.0 mm from the limbu): 45 patients , Group C1 group (straight-line incision with distance of 2.5 mm from the limbus): 54 patients, Group C2 group (anti-superciliary arch-shaped incision with distance of 2.5 mm from the limbus): 50 patients. All patients treated with small incision non-phacoemulsification cataract extraction and intraocular lens implantation and were examined by corneal topography and specular microscopy preoperatively , one week , one month and three months postoperatively. We compared mean corneal astigmatism, SRI, SAI and the density of corneal endothelium between different groups up to 3 months postoperatively.RESULTS(1) Mean corneal astigmatism between Group A1, Group B1, Group C1 were significantly different at 1 week postoperatively. Differences are significant (P=0.008). But there are no significant differences between the three groups at 1 month and 3 postoperatively (P > 0.05).(2) Mean corneal astigmatism between Group A2, Group B2, Group C2 were significantly different at 1 week postoperatively. Differences are significant (P<0.001). But there are no significant differences between the three groups at 1 month and 3 postoperatively (P > 0.05). (3) Mean corneal astigmatism between Group B1, Group B2 were significantly different at 1 week postoperatively. Differences are significant (P=0.031). But there are no significant differences between the three groups at 1 month and 3 postoperatively (P > 0.05). (4) Mean corneal astigmatism significantly different (P<0.05) at 1 week postoperatively were significantly different at 1 week postoperatively . Differences are significant (P=0.018). But there are no significant differences between the three groups at 1 month and 3 postoperatively (P > 0.05). (5) SRI were significantly different (P<0.05) at 1 week postoperatively between Group A1, Group B1, Group C1, between Group A2, Group B2, Group C2, between Group B1, Group B2, between Group C1, Group C2,respectively. SAI were only significantly different (P<0.05) at 1 week postoperatively significantly different at 1 week postoperatively. (6) The difference of changes in the density of corneal endothelium were not significant among groups with different incisions (P > 0. 05), and the difference of percentages of endothelium loss was not significantly either (P > 0. 05).CONCLUSIONIf incision location away from the corneal refractive center is farther, mean corneal astigmatism is smaller in the early time postoperatively. Anti-superciliary arch-shaped incision lead to smaller astigmatism in the early time postoperatively than straight-line incision. Cataract operation with different incisions does not produce significant influence on the loss of corneal endothelial cells.
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