Aims To examine whether long-term corneal astigmatic changes after stabilisation of surgically induced astigmatism (SIA) following cataract surgery differ among eyes having against-the-rule (ATR), with-the-rule (WTR), and oblique astigmatism.

Methods Anterior corneal astigmatism of 390 eyes in 390 patients (130 eyes each having ATR, WTR and oblique astigmatism) who underwent phacoemulsification with a horizontal clear corneal or scleral incision and 390 eyes in 390 control patients without surgery were examined using an auto-keratometer on the day that SIA stabilised (baseline) and at ≥8 years post baseline. Changes in corneal astigmatism during the ≥8 years post baseline were decomposed to vertical/horizontal (Rx) and oblique astigmatism components (Ry), and compared among baseline types of astigmatism and between eyes with and without surgery.

Results The mean corneal astigmatic changes (Rx and Ry) showed an ATR shift of 0.2–0.3 D during the ≥8 years post baseline, which did not differ significantly among the ATR, WTR and oblique astigmatism groups in eyes with and without surgery. In the ATR, WTR and oblique groups, the mean Rx and Ry did not differ significantly between eyes with and without surgery. Double angle plots revealed an equivalent degree of ATR change in the ATR, WTR and oblique groups between eyes with and without surgery.

Conclusion Long-term corneal astigmatic changes towards ATR astigmatism occurred to a similar extent in eyes having ATR, WTR, oblique astigmatism and were comparable between eyes with and without surgery, suggesting that astigmatism type need not be considered when planning astigmatism correction.