Purpose: To determine the significance of any association between either change in angle kappa (Κ°) or the rectilinear displacement (L, mm) of the first Purkinje image relative to the pupil center and unexpected changes in astigmatism after phacoemulsification.
Methods: Orbscan II (Bausch and Lomb) measurements were taken at 1, 2, and 3 months after unremarkable phacoemulsification in patients implanted with spherical (group 1, SA60AT, Alcon) or aspheric (group 2, SN60WF, Alcon) nontoric IOLs. The outputs were used to calculate L. Astigmatism, measured by autorefractometry and subjective refraction, was subjected to vector analysis (polar and cartesian formats) to determine the actual change induced over the periods 1-2 and 2-3 months postop.
Results: Chief findings were that the mean (n, ±SD, 95%CI) values for L over each period were as follows: Group 1, 0.407 (38, ±0.340, 0.299-0.521), 0.315 (23, ±0.184, 0.335-0.485); Group 2, 0.442 (45, ±0.423, 0.308-0.577), 0.372 (26, ±0.244, 0.335-0.485). Differences between groups were not significant. There was a significant linear relationship between (A) the change in Κ (ΔΚ = value at 1 month-value at 2 months) and Κ at 1 month (x), where ΔΚ =0.668-3.794X (r = 0.812, n = 38, P = <0.001) in group 1 and ΔΚ = 0.263x -1.462 (r = 0.494, n = 45, P = 0.002) in group 2, (B) L and the J45 vector describing the actual change in astigmatism between 1 and 2 months in group 2, where J45 (by autorefractometry) =0.287L-0.160 (r = 0.487, n = 38, P = 0.001) and J45 (by subjective refraction) =0.281L-0.102 (r = 0.490, n = 38, P = 0.002), and (C) J45 and ΔΚ between 2 and 3 months in group 2, where J45 (by subjective refraction) =0.086ΔΚ-0.063 (r = 0.378, n = 26, P = 0.020).
Conclusion: Changes in the location of the first Purkinje image relative to the pupil center after phacoemulsification contributes to changes in refractive astigmatism. However, the relationship between the induced change in astigmatism resulting from a change in L is not straightforward.
Keywords: Angle kappa; astigmatism; first Purkinje image; postphacoemulsification.