Refractive outcomes after limbal relaxing incisions or femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery

Abstract Objectives To compare the efficacy of astigmatic correction between simultaneous femtosecond laser-assisted intrastromal arcuate keratotomy (AK) combined with femtosecond laser-assisted cataract surgery (FLACS) and toric intraocular lens (IOL) implantation during cataract surgery in moderate astigmatism. Design: Retrospective observational study, tertiary care medical center Methods We retrospectively reviewed medical records of patients who underwent astigmatic correction via femtosecond laser-assisted intrastromal AK (AK group; 27 eyes of 27 patients) with FLACS or toric IOL implantation (toric IOL group; 21 eyes of 21 patients). All patients had senile cataracts with corneal astigmatism ranging from + 1.00 to + 2.00 diopters (D) before cataract surgery. We measured visual acuity, intraocular pressure, automated keratometry, manifest refraction and topography preoperatively and at 1-day, 1-month, 3-month, and 6-month postoperatively. Results Refractive astigmatism was significantly decreased in both groups. The mean preoperative and 6-month postoperative refractive astigmatism were 1.85 ± 1.07 and 0.99 ± 0.51 D, respectively, in the AK group (P = 0.028), and 1.84 ± 0.81 and 0.68 ± 0.21 D, respectively, in the toric IOL group (P < 0.001). There was no significant difference in refractive astigmatism between the two groups at 6-month postoperatively (0.99 ± 0.51 vs 0.68 ± 0.21 D, P = 0.057). At 6-month postoperatively, parameters for vector analysis of refractive astigmatism showed no statistical difference between the two groups. Corneal astigmatism was significantly decreased in the AK group. There was significant difference in corneal astigmatism from topography and automated keratometer between the two groups at 6-month postoperatively (0.94 ± 0.40 vs 1.53 ± 0.46 D, P = 0.018 for topography and 0.98 ± 0.69 vs 1.37 ± 0.41 D, P = 0.032 for automated keratometer). Conclusions Femtosecond laser-assisted intrastromal AK in FLACS could be an effective procedure for reducing astigmatism as well as toric IOL implantation in cataract surgery.

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Efficacy of astigmatic correction after femtosecond laser-guided cataract surgery using intraoperative aberrometry in eyes with low-to-moderate levels of corneal astigmatism

International Ophthalmology ◽

10.1007/s10792-020-01283-x ◽

2020 ◽

Vol 40 (5) ◽

pp. 1181-1189

Author(s):

Paz Orts ◽

David P. Piñero ◽

Salvador Aguilar ◽

Pedro Tañá

Keyword(s):

Femtosecond Laser ◽

Cataract Surgery ◽

Corneal Astigmatism

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Minimizing Surgically Induced Astigmatism at the Time of Cataract Surgery Using a Square Posterior Limbal Incision

Journal of Ophthalmology ◽

10.1155/2011/243170 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Paul Ernest ◽

Warren Hill ◽

Richard Potvin

Keyword(s):

Cataract Surgery ◽

Corneal Astigmatism ◽

Intraocular Lenses ◽

Corneal Incision ◽

Surgically Induced Astigmatism ◽

Clear Corneal Incision ◽

Refractive Outcomes ◽

Induced Astigmatism ◽

Surgically Induced ◽

Corneal Incisions

Purpose. To compare the surgically induced astigmatism from clear corneal and square posterior limbal incisions at the time of cataract surgery.Methods. Surgically induced astigmatism was calculated for a set of eyes after cataract surgery using a temporal 2.2 mm square posterior limbal incision. Results were compared to similar available data from surgeons using clear corneal incisions of similar size.Results. Preoperative corneal astigmatism averaged 1.0 D and was not significantly different between the incision types. Surgically induced astigmatism with the 2.2 mm posterior limbal incision averaged0.25±0.14 D, significantly lower in magnitude than the aggregate surgically induced astigmatism produced by the 2.2 mm clear corneal incision (0.68±0.49 D).Conclusion. The 2.2 mm square posterior limbal incision induced significantly less, and significantly less variable, surgically induced astigmatism relative to a similar-sized clear corneal incision. This is likely to improve refractive outcomes, particularly important with regard to premium intraocular lenses.

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A Meta-Analysis Comparing Postoperative Complications and Outcomes of Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification for Cataract

Journal of Ophthalmology ◽

10.1155/2017/3849152 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Zi Ye ◽

Zhaohui Li ◽

Shouzhi He

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Postoperative Complications ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Meta Analysis ◽

Cell Loss ◽

Corneal Endothelial Cell ◽

Endothelial Cell Loss ◽

Refractive Outcomes

Objective. This meta-analysis aimed to compare the outcomes and postoperative complications between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS). Methods. Bibliographic databases, including PubMed, Embase, and Cochrane library, were systematically searched for references on or before September 2015 regarding the outcomes and complications by FLACS or CPCS. Data on corneal endothelial cell loss, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive outcomes, and postoperative complications were retrieved. Results. A total of 9 trials were included in this analysis. Refractive outcomes (MD = −0.21, 95% CI: −0.39~0.03, P=0.02) were significantly improved after FLACS. Although corneal endothelial cell loss was not significantly reduced after FLACS, there was a trend towards lower corneal endothelial cell loss (mean difference (MD) = 197.82, 95% confidence interval (CI): 2.66~392.97, P=0.05) after FLACS. There was no significant difference in UDVA (MD = −0.01, 95% CI: −0.13~0.10, P=0.80) or CDVA (MD = −0.03, 95% CI: 0.07~0.00, P=0.09) between the two surgeries. Elevated intraocular pressure and macular edema were most commonly developed complications after cataract surgery, and the incidence of these complications associated with the two surgeries was similar. Conclusion. Compared with CPCS, FLACS might achieve higher refractive stability and corneal endothelial cell count. Nevertheless, further study is needed to validate our findings.

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Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery

Archivos de la Sociedad Española de Oftalmología (English Edition) ◽

10.1016/j.oftale.2020.09.008 ◽

2021 ◽

Author(s):

D. Lopes ◽

T. Loureiro ◽

R. Carreira ◽

S. Rodrigues Barros ◽

J. Nobre Cardoso ◽

...

Keyword(s):

Femtosecond Laser ◽

Cataract Surgery ◽

Corneal Astigmatism

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Astigmatic correction of simultaneous femtosecond laser-assisted cataract surgery (FLACS) with intrastromal arcuate keratotomy (ISAK) versus Toric intraocular Lens Impantation with conventional phacoemulsification

BMC Ophthalmology ◽

10.1186/s12886-021-02059-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hye Ji Kwon ◽

Hun Lee ◽

Jin Ah. Lee ◽

Jae Yong Kim ◽

Hungwon Tchah

Keyword(s):

Femtosecond Laser ◽

Cataract Surgery ◽

Intraocular Lens ◽

Retrospective Chart Review ◽

Corneal Astigmatism ◽

Vector Analysis ◽

Toric Intraocular Lens ◽

Toric Iol ◽

Iol Implantation ◽

Significant Difference

Abstract Background To compare the efficacies in astigmatic correction of simultaneous femtosecond laser-assisted cataract surgery (FLACS) with intrastromal arcuate keratotomy (ISAK) versus toric intraocular lens (IOL) implantation with conventional phacoemulsification in moderate astigmatism. Methods A retrospective chart review was conducted for patients who had undergone cataract surgery by one surgeon. We identified patients with preoperative corneal astigmatism from + 0.75 to + 2.00 diopters (D) who had undergone astigmatic correction with FLACS with ISAK or toric IOL implantation with conventional phacoemulsification. We measured the visual acuity, intraocular pressure, automated keratometer, manifest refraction, and topography preoperatively and 1-day, 1-month, 3-month, and 6-month postoperatively. The vector analysis of refractive astigmatism was performed. Results Of a total of 48 eyes of 48 patients, 27 eyes of 27 patients had FLACS with ISAK (AK group), and 21 eyes of 21 patients had conventional cataract surgery with toric IOL implantation (toric IOL group). Refractive astigmatism was significantly decreased in both groups. The mean preoperative and 6-month postoperative refractive astigmatism were 1.85 ± 1.07 and 0.99 ± 0.51 D, respectively, in the AK group (P = 0.028), and 1.84 ± 0.81 and 0.68 ± 0.21 D, respectively, in the toric IOL group (P < 0.001). There was no significant difference in refractive astigmatism between the two groups at 6-month postoperatively (0.99 ± 0.51 vs 0.68 ± 0.21 D, P = 0.057). At 6-month postoperatively, parameters for vector analysis of refractive astigmatism showed no statistical difference between the two groups. Corneal astigmatism was significantly decreased in the AK group. Corneal astigmatism from topography and the automated keratometer were significantly lower in the AK group 6-month postoperatively compared to toric IOL group (0.94 ± 0.40 vs. 1.53 ± 0.46 D, P = 0.018 for topography; and 0.98 ± 0.69 vs. 1.37 ± 0.41 D, P = 0.032 for the automated keratometer). Conclusions FLACS with ISAK could be an effective procedure for reducing astigmatism as well as toric IOL implantation in cataract surgery.

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Refractive Outcomes of Femtosecond Laser-assisted Cataract Surgery with Arcuate Keratotomy and Standard Phacoemulsification with Toric Intraocular Lens Implantation

10.21203/rs.3.rs-142481/v1 ◽

2021 ◽

Author(s):

Meng-Yin Lin ◽

Yun-Dun Shen ◽

Hsin-Yuan Tan ◽

I-Jong Wang ◽

I-Chan Lin

Keyword(s):

Femtosecond Laser ◽

Cataract Surgery ◽

Intraocular Lens ◽

Postoperative Outcome ◽

Intraocular Lens Implantation ◽

Toric Intraocular Lens ◽

Toric Iol ◽

Iol Implantation ◽

Refractive Outcomes ◽

Lens Implantation

Abstract Background: Both femtosecond laser-assisted arcuate keratotomy (FS-AK) and toric intraocular lens (IOL) implantation were effective in correction for eyes with corneal astigmatism. The objective of this study was to evaluate the postoperative refractive outcomes of patients receiving femtosecond laser-assisted cataract surgery (FLACS) with FS-AK and patients receiving standard phacoemulsification with toric intraocular lens implantation Methods: This retrospective study reviewed the postoperative outcome of patients undergoing FLACS with FS-AK (FS-AK group) and patients undergoing standard phacoemulsification with toric IOL implantation (toric IOL group). The main outcome measures were bare and corrected visual acuities, keratometric and refractive astigmatism, and vector analysis.Results: The FL-AK group included 41 eyes with preoperative keratometric astigmatism of −1.64 diopters (D) ± 0.42 (standard deviation), and the toric IOL group included 53 eyes with preoperative keratometric astigmatism of −2.29 ± 0.91 D (P < 0.001). Postoperative refractive astigmatism was comparable between the two groups. Postoperative bare vision was significantly better (P = 0.005) and corrected visual acuity was marginally better in the toric IOL group than in the FS-AK group (P = 0.051). The absolute angles of error were 9.95 ± 9.57 degrees and 5.08 ± 4.94 degrees (P = 0.02) in the FS-AK and toric IOL groups, respectively.Conclusion: Both FLACS with FS-AK and standard phacoemulsification with toric IOL implantation represent safe and effective methods for astigmatism correction at the time of cataract surgery. Standard phacoemulsification with toric IOL implantation achieves better visual outcome than combined FLACS and FS-AK at 6-month follow up.

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