Aims To compare astigmatism with clear corneal incision versus scleral tunnel incision following paediatric cataract surgery with primary intraocular lens implantation.

Methods Retrospective, comparative case series of 218 eyes of 138 children <12 years of age undergoing cataract extraction with intraocular lens implantation. The study cohorts were grouped into two categories based on incision location: group 1 comprising 108 eyes from 65 children with scleral incision; group 2 comprising 110 eyes from 73 children with clear corneal incision. Cycloplegic refraction was performed at 1, 3 and 6 months postoperatively.

Results The mean age in group 1 was 61±39 months and in group 2, 51±41 months. The mean postoperative astigmatism in group 1 was 1.28±0.97 D, 1.42±1.00 D and 1.38±0.98 D at 1, 3 and 6 months respectively. The change in astigmatism between 1 and 6 months was non-significant (p=0.26). The mean astigmatism in group 2 was 1.34±1.20 D, 1.13±0.88 D and 1.03±0.89 D at 1, 3 and 6 months respectively. Astigmatism in group 2 decreased significantly with time (p<0.001). The amount of astigmatism was comparable between the two groups at 1 month postsurgery (p=0.90), while it was significantly lower in the corneal incision group at 3 (p=0.03) and 6 months (p=0.01).

Conclusions Postoperative astigmatism after paediatric cataract surgery by clear corneal incision was lower compared with scleral incision. However, the difference was small and clinically insignificant.