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July 1989

Natural Evolution of Postoperative Astigmatism

Author Affiliations

Houston, Tex

Arch Ophthalmol. 1989;107(7):956. doi:10.1001/archopht.1989.01070020018011

To the Editor.  —I congratulate Drs Parker and Clorfeine1 for showing the natural evolution of postoperative astigmatism after planned extracapsular cataract extraction using a limbal incision and interrupted 10-0 nylon sutures. Their study shows what has been known for a long time—that a limbal incision closed with any type of suture will show a drift toward against-the-rule-induced astigmatism. Their study also points out the fallacy of evaluating the postoperative astigmatism until all the sutures are cut or have been removed or absorbed. Many published studies report results after 3 to 6 months that can be completely erroneous. This study also points out the fallacy of attempting to correct astigmatism by tangential keratotomy at the time of surgery. How do you know what to correct when you do not know what the postoperative astigmatism really is?I have shown that the use of a scleral tunnel1,2 (actually

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