Background: The number of patients undergoing cataract surgery in Australia has increased significantly over the past five years. This is at least partly related to technical improvements in phacoemulsification resulting in greater intra‐operative safety. However, phacoemulsification does not necessarily lead to the best optical outcome from cataract surgery. This paper reviews the interaction between cataract surgery and corneal topography and uses case reports to discuss the planning of cataract surgery based on pre‐operative refraction.Discussion: Corneal astigmatism induced by cataract surgery may be considered in two main groups, that caused by the incision and that caused by sutures. The location and length of the incisions, wound construction and the manner of wound closure determine the corneal topographic outcome of cataract surgery. Since the incisions vary for extracapsular cataract extraction (ECCE) and phacoemulsification cataract extraction (PECE), they induce different patterns of corneal topographic change. Each procedure has its advantages, but PECE tends to change the topography less, leading to more rapid visual rehabilitation. However, PECE does not always result in less final astigmatism. Practitioners should consider their role in the management of cataract patients to include planning the best type of surgery and the best post‐surgical intervention for an optimal optical outcome.(Clin Exp Optom1996; 79: 6: 23
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