ABSTRACT.Purpose: To investigate the value of posterior keratometry in the assessment of surgically induced astigmatic change (AC) in cataract surgery, with particular emphasis on the influence of test-retest variability. Methods: Seventy-seven eyes of 77 cataract patients scheduled for routine cataract surgery were enrolled. All patients received a 2.2-mm self-sealing scleral incision (n = 24), single-plane clear corneal incision (SPCCI; n = 29) or biplanar clear corneal incision (BPCCI; n = 24). Measurements of anterior and posterior corneal astigmatism were performed with a rotating Scheimpflug camera (Pentacam HR) preoperatively and postoperatively. Two repeated readings were taken preoperatively to assess the role of the test-retest effect. Astigmatic change (AC) was analysed according to the polar value method. Results: On the anterior corneal surface, SPCCIs and BPCCIs caused a statistically significant mean flattening of the incisional meridian of 0.37 and 0.27 dioptres (D), respectively. Scleral incisions on average did not cause AC, although steepening, flattening or torque beyond the test-retest effect was observed in individual cases. On the posterior surface, mean power changes in the incisional meridian were below 0.1 D for all incisions, and these changes were of the same order of magnitude as the test-retest effect. Conclusion: Surgically induced AC of the posterior corneal surface after cataract surgery is of negligible clinical relevance. Moreover, it is of the same order of magnitude as the test-retest variability of the measurement device and therefore cannot (yet) be reliably assessed.

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There is no consensus on whether and when surgical treatment is indicated for combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). We aim to discuss the benefits of surgical intervention and techniques that may improve the outcome. A 24-year-old man experienced progressive visual loss for 6 months in his left eye due to CHRRPE. At presentation, visual acuity was 1.3 LogMAR and fundoscopy revealed extensive tractional pre- and epiretinal membranes, subretinal exudation, and a vasoproliferative tumor in the inferior periphery. A complete vitrectomy was performed, while paying special attention to vitreous shaving at the vitreous base and removal of vitreoschisis-induced vitreous cortex remnants (VCR) from the retinal surface posterior to the vitreous base. Tractional membranes and internal limiting membrane were peeled, and the vasoproliferative tumor was excised. Silicone oil tamponade was removed 11 weeks after surgery. No intra- or postoperative complications occurred. Visual acuity improved to 0.8 LogMAR and remained stable for 48-month follow-up. Vitreoretinal surgery can prevent complications that occur with CHRRPE. In addition, visual function may improve even if the initial visual acuity is low. Timely and complete vitrectomy with extensive membranectomy and detection and removal of VCR is recommended to avoid complications in challenging CHRRPE.