{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:54:25Z","timestamp":1793321665794,"version":"4.5.0"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>Cataract remains a major cause of visual impairment worldwide including in India. The sutureless manual small-incision cataract surgery (MSICS) as an alternative to phacoemulsification, gives equivalent visual results at lower expenses. Still the procedure is often discredited for higher astigmatism due to the larger size of the incision. High astigmatism is an important cause of poor uncorrected visual acuity after cataract surgery. However, there are enough studies in the literature to prove that surgically induced astigmatism (SIA) can be minimized and also eliminated by adopting appropriate wound construction techniques during surgery. Even pre-existing astigmatism if any can be neutralized by changing wound architecture during surgery. Here, we review the various techniques of scleral tunnel construction described in the literature to care for postoperative astigmatism in MSICS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_1627_22","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T10:52:06Z","timestamp":1667213526000},"page":"3785-3790","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":16,"title":["Postoperative astigmatic considerations in manual small-incision cataract surgery - A review"],"prefix":"10.4103","volume":"70","author":[{"given":"Sabyasachi","family":"Pattanayak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satanshu","family":"Mathur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok K","family":"Nanda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B Nageswar Rao","family":"Subudhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-14-20240828","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/APO.0b013e318249f7b9","article-title":"Manual small incision cataract surgery:A review","volume":"1","author":"Venkatesh","year":"2012","journal-title":"Asia-Pac J Ophthalmol"},{"key":"R2-14-20240828","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.ajo.2006.07.023","article-title":"A prospective randomized clinical trial of phacoemulsification vs manual sutureless small-incision extracapsular cataract surgery in Nepal","volume":"143","author":"Ruit","year":"2007","journal-title":"Am J Ophthalmol"},{"key":"R3-14-20240828","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/ICU.0b013e3283414fb3","article-title":"Phacoemulsification versus extracapsular cataract extraction:Where do we stand?","volume":"22","author":"Pershing","year":"2011","journal-title":"Curr Opin Ophthalmol"},{"key":"R4-14-20240828","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1016\/j.jcrs.2010.05.025","article-title":"Phacoemulsification versus manual small-incision cataract surgery for white cataract","volume":"36","author":"Venkatesh","year":"2010","journal-title":"J Cataract Refract Surg"},{"key":"R5-14-20240828","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.ophtha.2006.08.057","article-title":"Why do phacoemulsification?Manual small-incision cataract surgery is almost as effective, but less expensive","volume":"114","author":"Gogate","year":"2007","journal-title":"Ophthalmology"},{"key":"R6-14-20240828","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1136\/bjo.86.5.543","article-title":"Does prospective monitoring improve cataract surgery outcomes in Africa?","volume":"86","author":"Yorston","year":"2002","journal-title":"Br J Ophthalmol"},{"key":"R7-14-20240828","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1016\/j.ophtha.2004.11.055","article-title":"Safety and efficacy of phacoemulsification compared with manual small-incision cataract surgery by a randomized controlled clinical trial:Six-week results","volume":"112","author":"Gogate","year":"2005","journal-title":"Ophthalmology"},{"key":"R8-14-20240828","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1080\/09286580490888762","article-title":"Economic cost of cataract surgery procedures in an established eye care centre in Southern India","volume":"11","author":"Muralikrishnan","year":"2004","journal-title":"Ophthalmic Epidemiol"},{"key":"R9-14-20240828","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s12009-007-0020-y","article-title":"Site of incision and corneal astigmatism in conventional SICS versus phacoemulsification","volume":"39","author":"Reddy","year":"2007","journal-title":"Ann Ophthalmol"},{"key":"R10-14-20240828","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0146-2776(80)80071-1","article-title":"Clinical evaluation of the Terry surgical keratometer","volume":"6","author":"Colvard","year":"1980","journal-title":"Am Intra-Ocul Implant Soc J"},{"key":"R12-14-20240828","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1136\/bjo.76.5.300","article-title":"Optimal postoperative refraction for good unaided near and distance vision with monofocal intraocular lenses","volume":"76","author":"Bradbury","year":"1992","journal-title":"Br J Ophthalmol"},{"key":"R13-14-20240828","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.survophthal.2003.10.010","article-title":"Practical astigmatism analysis for refractive outcomes in cataract and refractive surgery","volume":"49","author":"Alpins","year":"2004","journal-title":"Surv Ophthalmol"},{"key":"R14-14-20240828","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/S0886-3350(98)80287-3","article-title":"Comparison of surgically induced astigmatism after sutureless temporal clear corneal and scleral frown incisions","volume":"24","author":"Huang","year":"1998","journal-title":"J Cataract Refract Surg"},{"key":"R15-14-20240828","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S0886-3350(13)81018-8","article-title":"Conversion of keratometer readings to polar values","volume":"16","author":"Naeser","year":"1990","journal-title":"J Cataract Refract Surg"},{"key":"R16-14-20240828","first-page":"1615","article-title":"The pathophysiology of corneal astigmatism after cataract","volume":"79","author":"Jaffe","year":"1975","journal-title":"Trans Am Acad Ophthalmol Otolaryngol"},{"key":"R17-14-20240828","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1001\/archopht.1986.01050240099048","article-title":"Excimer laser ablation of the lens","volume":"104","author":"Nanevicz","year":"1986","journal-title":"Arch Ophthalmol"},{"key":"R18-14-20240828","first-page":"5","article-title":"A comparison of the effectiveness and cost effectiveness of three different methods of cataract extraction in relation to the magnitude of postoperative astigmatism","volume":"15","author":"Muralikrishnan","year":"2003","journal-title":"Asia Pacific J Ophthalmol"},{"key":"R19-14-20240828","doi-asserted-by":"crossref","first-page":"9","DOI":"10.4103\/0301-4738.44491","article-title":"Wound construction in manual small incision cataract surgery","volume":"57","author":"Haldipurkar","year":"2009","journal-title":"Indian J Ophthalmol"},{"key":"R20-14-20240828","doi-asserted-by":"crossref","first-page":"54","DOI":"10.3126\/nepjoph.v4i1.5851","article-title":"Comparison of astigmatism following manual small incision cataract surgery:Superior versus temporal approach","volume":"4","author":"Malik","year":"2012","journal-title":"Nepal J Ophthalmol"},{"key":"R21-14-20240828","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/S0886-3350(97)80176-9","article-title":"Corneal versus scleral tunnel incision in cataract surgery:A randomized study","volume":"23","author":"Olsen","year":"1997","journal-title":"J Cataract Refract Surg"},{"key":"R22-14-20240828","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/S0886-3350(96)80274-4","article-title":"Posterior limbal incision","volume":"22","author":"Ernest","year":"1996","journal-title":"J Cataract Refract Surg"},{"key":"R23-14-20240828","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1016\/S0886-3350(99)00148-0","article-title":"Extracapsular cataract extraction with a sutureless incision for dense cataracts","volume":"25","author":"Kimura","year":"1999","journal-title":"J Cataract Refract Surg"},{"key":"R24-14-20240828","doi-asserted-by":"crossref","first-page":"201","DOI":"10.4103\/0301-4738.16684","article-title":"Reduction in astigmatism in manual small incision cataract surgery through change of incision site","volume":"53","author":"Gokhale","year":"2005","journal-title":"Indian J Ophthalmol"},{"key":"R26-14-20240828","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2016\/9489036","article-title":"Postoperative corneal and surgically induced astigmatism following superior approach manual small incision cataract surgery in patients with preoperative against-the-rule astigmatism","volume":"2016","author":"Arthur","year":"2016","journal-title":"J Ophthalmol"},{"key":"R27-14-20240828","first-page":"1229","article-title":"A comparative study on the superior, supero-temporal and the temporal inci- sions in small incision cataract surgeries for post operative astigmatism","volume":"6","author":"Pawar","year":"2012","journal-title":"J Clin Diagn Res"},{"key":"R28-14-20240828","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1016\/S0886-3350(00)00484-3","article-title":"Controlling astigmatism in cataract surgery requiring relatively large self-sealing incisions","volume":"26","author":"Akura","year":"2000","journal-title":"J Cataract Refract Surg"},{"key":"R29-14-20240828","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S0886-3350(13)80478-6","article-title":"Prospective evaluation of surgically induced astigmatism and astigmatic keratotomy effects of various self-sealing small incisions","volume":"21","author":"Nielsen","year":"1995","journal-title":"J Cataract Refract Surg"},{"key":"R30-14-20240828","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3126\/nepjoph.v3i1.4273","article-title":"A comparative study of sclerocorneal and clear corneal tunnel incision in manual small-incision cataract surgery","volume":"3","author":"Archana","year":"1970","journal-title":"Nepal J Ophthalmol"},{"key":"R31-14-20240828","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/S0886-3350(13)80470-1","article-title":"Origin of the scleral tunnel incision","volume":"21","author":"Girard","year":"1995","journal-title":"J Cataract Refract Surg"},{"key":"R32-14-20240828","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1016\/S0886-3350(13)80687-6","article-title":"Chevron sutureless closure:A preliminary report","volume":"17","author":"Pallin","year":"1991","journal-title":"J Cataract Refract Surg"},{"key":"R33-14-20240828","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/S0886-3350(13)80683-9","article-title":"Frown incision for minimizing induced astigmatism after small incision cataract surgery with rigid optic intraocular lens implantation","volume":"17","author":"Singer","year":"1991","journal-title":"J Cataract Refract Surg"},{"key":"R34-14-20240828","first-page":"1001","article-title":"Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery","volume":"7","author":"Jauhari","year":"2014","journal-title":"Int J Ophthalmol"},{"key":"R35-14-20240828","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/S0886-3350(13)80175-7","article-title":"Induced astigmatism in a 6.0 mm no-stitch frown incision","volume":"20","author":"Sinskey","year":"1994","journal-title":"J Cataract Refract Surg"},{"key":"R36-14-20240828","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.4103\/ijo.IJO_308_22","article-title":"Early postoperative astigmatism in 2-mm manual small incision cataract surgery with phacofracture","volume":"70","author":"Sahu","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"R37-14-20240828","first-page":"195","article-title":"Extracapsular cataract extraction:Surgical techniques","volume":"41","author":"Basti","year":"1993","journal-title":"Indian J Ophthalmol"},{"key":"R38-14-20240828","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/S0886-3350(97)80175-7","article-title":"Postoperative astigmatism and relative strength of tunnel incisions:A prospective clinical trial","volume":"23","author":"Anders","year":"1997","journal-title":"J Cataract Refract Surg"},{"key":"R39-14-20240828","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.4103\/ijo.IJO_1627_22","article-title":"Effect of depth of the sclerocorneal incision on postoperative corneal astigmatism in manual small-incision cataract surgery","volume":"70","author":"Pattanayak","year":"2022","journal-title":"Indian J Ophthalmol"},{"key":"R40-14-20240828","doi-asserted-by":"crossref","first-page":"606","DOI":"10.4103\/0301-4738.167113","article-title":"Comparison of surgically induced astigmatism between horizontal and X-pattern sutures in the scleral tunnel incisions for manual small incision cataract surgery","volume":"63","author":"Eslami","year":"2015","journal-title":"Indian J Ophthalmol"},{"key":"R41-14-20240828","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1136\/bjo.87.6.667","article-title":"Extracapsular cataract surgery compared with manual small incision cataract surgery in community eye care setting in western India:A randomised controlled trial","volume":"87","author":"Gogate","year":"2003","journal-title":"Br J Ophthalmol"},{"key":"R42-14-20240828","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1136\/bjo.2004.063479","article-title":"Outcomes of high volume cataract surgeries in a developing country","volume":"89","author":"Venkatesh","year":"2005","journal-title":"Br J Ophthalmol"},{"key":"R43-14-20240828","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1097\/00006324-197106000-00002","article-title":"Changes in corneal astigmatism with age*","volume":"48","author":"Lyle","year":"1971","journal-title":"Optom Vis Sci"},{"key":"R44-14-20240828","first-page":"249","article-title":"Cataract blindness - challenges for the 21st century","volume":"79","author":"Brian","year":"2001","journal-title":"Bull World Health Organ"},{"key":"R45-14-20240828","doi-asserted-by":"crossref","first-page":"748","DOI":"10.5301\/EJO.2011.6521","article-title":"Safety and efficacy of temporal manual small incision cataract surgery in India","volume":"21","author":"Zawar","year":"2011","journal-title":"Eur J Ophthalmol"},{"key":"R46-14-20240828","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/S0886-3350(02)01483-9","article-title":"Bacterial endophthalmitis after small-incision cataract surgery:Effect of incision placement and intraocular lens type","volume":"29","author":"Nagaki","year":"2003","journal-title":"J Cataract Refract Surg"},{"key":"R48-14-20240828","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S0886-3350(13)80322-7","article-title":"The gliding nucleus","volume":"19","author":"Blumenthal","year":"1993","journal-title":"J Cataract Refract Surg"},{"key":"R49-14-20240828","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/S0886-3350(01)01263-9","article-title":"Minimal astigmatism after sutureless planned extracapsular cataract extraction","volume":"28","author":"Burgansky","year":"2002","journal-title":"J Cataract Refract Surg"},{"key":"R50-14-20240828","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/S0886-3350(98)80293-9","article-title":"Three year prospective, randomized evaluation of intraocular lens implantation through 3.2 and 5.5 mm incisions","volume":"24","author":"Oshika","year":"1998","journal-title":"J Cataract Refract Surg"},{"key":"R51-14-20240828","doi-asserted-by":"crossref","first-page":"328","DOI":"10.4103\/0301-4738.182953","article-title":"Comparison of surgically induced astigmatism between horizontal and X-pattern sutures in the scleral tunnel incisions for manual small incision cataract surgery","volume":"64","author":"Goel","year":"2016","journal-title":"Indian J Ophthalmol"},{"key":"R52-14-20240828","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1080\/09286580591005778","article-title":"Comparison of endothelial cell loss and surgically induced astigmatism following conventional extracapsular cataract surgery, manual small-incision surgery and phacoemulsification","volume":"12","author":"George","year":"2005","journal-title":"Ophthalmic Epidemiol"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijo.IJO_1627_22","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:14:07Z","timestamp":1787757247000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijo.IJO_1627_22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11]]},"references-count":49,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_1627_22","relation":{},"ISSN":["0301-4738"],"issn-type":[{"value":"0301-4738","type":"print"}],"subject":[],"published":{"date-parts":[[2022,11]]}}}