Skip to main content
Log in

Refractive outcomes of femtosecond laser-assisted cataract surgery with arcuate keratotomy and standard phacoemulsification with toric intraocular lens implantation

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

A Correction to this article was published on 02 August 2022

This article has been updated

Abstract

Purpose

Femtosecond laser arcuate keratotomy (FS-AK) and toric intraocular lens (IOL) implantation are effective for the correction of eyes with corneal astigmatism. In this study, the postoperative refractive outcomes of patients receiving femtosecond laser-assisted cataract surgery (FLACS) with FS-AK and patients receiving standard phacoemulsification with toric IOL implantation were evaluated.

Methods

This retrospective study reviewed the postoperative outcomes of patients undergoing FLACS with FS-AK (the FS-AK group) and patients undergoing standard phacoemulsification with toric IOL implantation (the toric IOL group). The main outcome measures were uncorrected and corrected visual acuities, keratometric and refractive astigmatism, and vector analysis.

Results

The FS-AK group included 41 eyes with preoperative keratometric astigmatism of − 1.64 ± 0.42 diopters (D), 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. Compared with the FS-AK group, postoperative uncorrected visual acuity was significantly better (P = 0.005) and corrected visual acuity was marginally better in the toric IOL group (P = 0.051). The absolute angles of error were 9.95° ± 9.57° and 5.08° ± 4.94° (P = 0.02) in the FS-AK and the toric IOL groups, respectively.

Conclusion

Both FLACS with FS-AK and standard phacoemulsification with toric IOL implantation are safe and effective methods for astigmatism correction during cataract surgery. Standard phacoemulsification with toric IOL implantation achieves better visual acuity than FLACS with FS-AK at the 6-month follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets used and/or analyzed in the current study are available from the corresponding author on reasonable request.

Change history

References

  1. Gibbons A, Ali TK, Waren DP, Donaldson KE (2016) Causes and correction of dissatisfaction after implantation of presbyopia-correcting intraocular lenses. Clin Ophthalmol 10:1965–1970

    Article  Google Scholar 

  2. Ferrer-Blasco T, Montes-Mico R, Peixoto-de-Matos SC, González-Méijome JM, Cerviño A (2009) Prevalence of corneal astigmatism before cataract surgery. J Cataract Refract Surg 35:70–75

    Article  Google Scholar 

  3. Poll JT, Wang L, Koch DD, Weikert MP (2011) Correction of astigmatism during cataract surgery: toric intraocular lens compared to peripheral corneal relaxing incisions. J Refract Surg 27:165–171

    Article  Google Scholar 

  4. Eliwa TF, Abdellatif MK, Hamza II (2016) Effect of limbal relaxing incisions on corneal aberrations. J Refract Surg 32:156–162

    Article  Google Scholar 

  5. Kymionis GD, Yoo SH, Ide T, Culbertson WW (2009) Femtosecond-assisted astigmatic keratotomy for post-keratoplasty irregular astigmatism. J Cataract Refract Surg 35:11–13

    Article  Google Scholar 

  6. Khoramnia R, Salgado JP, Lohmann CP, Kobuch KA, von Mohrenfels CW (2012) Precision, morphology, and histology of corneal flap cuts using a 200-kHz femtosecond laser. Eur J Ophthalmol 22:161–167

    Article  Google Scholar 

  7. Santhiago MR, Kara-Junior N (2014) Waring GO 4th (2014) Microkeratome versus femtosecond flaps: accuracy and complications. Curr Opin Ophthalmol 25:270–274

    Article  Google Scholar 

  8. Hoffart L, Proust H, Matonti F, Conrath J, Ridings B (2009) Correction of postkeratoplasty astigmatism by femtosecond laser compared with mechanized astigmatic keratotomy. Am J Ophthalmol 147(779–787):787.e771

    Google Scholar 

  9. Nubile M, Carpineto P, Lanzini M, Calienno R, Agnifili L, Ciancaglini M et al (2009) Femtosecond laser arcuate keratotomy for the correction of high astigmatism after keratoplasty. Ophthalmology 116:1083–1092

    Article  Google Scholar 

  10. Ruckl T, Dexl AK, Bachernegg A, Reischl V, Riha W, Ruckhofer J et al (2013) Femtosecond laser-assisted intrastromal arcuate keratotomy to reduce corneal astigmatism. J Cataract Refract Surg 39:528–538

    Article  Google Scholar 

  11. Chan TC, Ng AL, Cheng GP, Wang Z, Woo VCP, Jhanji V (2016) Corneal astigmatism and aberrations after combined femtosecond-assisted phacoemulsification and arcuate keratotomy: two-year results. Am J Ophthalmol 170:83–90

    Article  Google Scholar 

  12. Holland E, Lane S, Horn JD, Ernest P, Arleo R, Miller KM (2010) The AcrySof Toric intraocular lens in subjects with cataracts and corneal astigmatism: a randomized, subject-masked, parallel-group, 1-year study. Ophthalmology 117:2104–2111

    Article  Google Scholar 

  13. Waltz KL, Featherstone K, Tsai L, Trentacost D (2015) Clinical outcomes of TECNIS toric intraocular lens implantation after cataract removal in patients with corneal astigmatism. Ophthalmology 122:39–47

    Article  Google Scholar 

  14. Yoo A, Yun S, Kim JY, Kim MJ, Tchah H (2015) Femtosecond laser arcuate keratotomy versus toric IOL implantation for correcting astigmatism. J Refract Surg 31:574–578

    Article  Google Scholar 

  15. Day AC, Stevens JD (2016) Predictors of femtosecond laser intrastromal astigmatic keratotomy efficacy for astigmatism management in cataract surgery. J Cataract Refract Surg 42:251–257

    Article  Google Scholar 

  16. Blehm C, Potvin R (2017) Pseudophakic astigmatism reduction with femtosecond laser-assisted corneal arcuate incisions: a pilot study. Clin Ophthalmol 11:201–207

    Article  Google Scholar 

  17. Alpins N (2001) Astigmatism analysis by the Alpins method. J Cataract Refract Surg 27:31–49

    Article  CAS  Google Scholar 

  18. Entabi M, Harman F, Lee N, Bloom PA (2011) Injectable 1-piece hydrophilic acrylic toric intraocular lens for cataract surgery: efficacy and stability. J Cataract Refract Surg 37:235–240

    Article  Google Scholar 

  19. Stewart CM, McAlister JC (2010) Comparison of grafted and non-grafted patients with corneal astigmatism undergoing cataract extraction with a toric intraocular lens implant. Clin Exp Ophthalmol 38:747–757

    Article  Google Scholar 

  20. Gray B, Huang LC, Hill J, Salvador-Silva M, Gwon A, Binder P (2012) Comparison of postoperative wound healing following penetrating or intrastromal corneal arcuate incisions in rabbit eyes performed with a diamond blade or femtosecond laser. Invest Ophthalmol Vis Sci 53:3529

    Google Scholar 

  21. Popovic M, Campos-Moller X, Schlenker MB, Ahmed IIK (2016) Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: a meta-analysis of 14 567 eyes. Ophthalmology 123:2113–2126

    Article  Google Scholar 

  22. Titiyal JS, Khatik M, Sharma N et al (2014) Toric intraocular lens implantation versus astigmatic keratotomy to correct astigmatism during phacoemulsification. J Cataract Refract Surg 40:741–747

    Article  Google Scholar 

  23. Kumar NL, Kaiserman I, Shehadeh-Mashor R, Sansanayudh W, Ritenour R, Rootman DS (2010) IntraLase-enabled astigmatic keratotomy for post-keratoplasty astigmatism: on-axis vector analysis. Ophthalmology 117:1228-1235.e1221

    Article  Google Scholar 

  24. Bahar I, Levinger E, Kaiserman I, Sansanayudh W, Rootman DS (2008) IntraLase-enabled astigmatic keratotomy for postkeratoplasty astigmatism. Am J Ophthalmol 146:897-904.e891

    Article  Google Scholar 

  25. Chen W, Zuo C, Chen C, Su J, Luo L, Congdon N, Liu Y (2013) Prevalence of corneal astigmatism before cataract surgery in Chinese patients. J Cataract Refract Surg 39:188–192

    Article  Google Scholar 

  26. Koch DD, Ali SF, Weikert MP, Shirayama M, Jenkins R, Wang L (2012) Contribution of posterior corneal astigmatism to total corneal astigmatism. J Cataract Refract Surg 38:2080–2087

    Article  Google Scholar 

Download references

Acknowledgements

This manuscript was edited by Wallace Academic Editing.

Funding

This study did not receive any funding.

Author information

Authors and Affiliations

Authors

Contributions

LMY performed data collection. LMY, HYT, and LIC conceived and drafted the manuscript. LMY, SYD, HYT, WIJ, and LIC contributed to the study design. LMY performed the statistical analysis and LIC contributed to data interpretation. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to I-Chan Lin.

Ethics declarations

Conflict of interest

All authors have read and approved the final manuscript and do not have any financial interest. The authors declare that they have no competing or proprietary interests.

Ethics approval

The Joint Institutional Review Board Committee of Taipei Medical University approved the study protocol (TMU-JIRB N201802025).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: The corresponding author’s name is updated as “I-Chan Lin"

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 KB)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, MY., Shen, YD., Tan, HY. et al. Refractive outcomes of femtosecond laser-assisted cataract surgery with arcuate keratotomy and standard phacoemulsification with toric intraocular lens implantation. Int Ophthalmol 42, 2633–2642 (2022). https://doi.org/10.1007/s10792-021-02090-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-021-02090-8

Keywords

Navigation