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.
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
02 August 2022
A Correction to this paper has been published: https://doi.org/10.1007/s10792-022-02358-7
References
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
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
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
Eliwa TF, Abdellatif MK, Hamza II (2016) Effect of limbal relaxing incisions on corneal aberrations. J Refract Surg 32:156–162
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
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
Santhiago MR, Kara-Junior N (2014) Waring GO 4th (2014) Microkeratome versus femtosecond flaps: accuracy and complications. Curr Opin Ophthalmol 25:270–274
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
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
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
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
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
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
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
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
Blehm C, Potvin R (2017) Pseudophakic astigmatism reduction with femtosecond laser-assisted corneal arcuate incisions: a pilot study. Clin Ophthalmol 11:201–207
Alpins N (2001) Astigmatism analysis by the Alpins method. J Cataract Refract Surg 27:31–49
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
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
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
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
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
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
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
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
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
Acknowledgements
This manuscript was edited by Wallace Academic Editing.
Funding
This study did not receive any funding.
Author information
Authors and Affiliations
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
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.
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.
About this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-021-02090-8