Dataset Information

Femtosecond laser-assisted arcuate keratotomy for the management of corneal astigmatism in patients undergoing cataract surgery: Comparison with conventional cataract surgery.

ABSTRACT:

Purpose

To assess the effects of femtosecond laser arcuate keratotomy with femtosecond laser-assisted cataract surgery in the management of corneal astigmatism, compared with conventional phacoemulsification cataract surgery.

Design

Retrospective comparative interventional case series.

Methods

A total of 2,498 eyes of consecutive patients who presented with 3.00 diopters (D) or under of astigmatism were included. The patients were treated with conventional phacoemulsification cataract surgery (conventional group) and femtosecond laser arcuate keratotomy with femtosecond laser-assisted cataract surgery (femtosecond group).

Results

Surgically induced astigmatism (SIA) was higher in the femtosecond group than the conventional group (0.215, p < 0.001). Difference vector (DV) was lower in the femtosecond group (-0.136, p < 0.001). The cut-off value of the overcorrection in the femtosecond group was 0.752 D of target induced astigmatism (TIA). For patients with TIA 0.75 D or under, DV and the value of index of success (TIA into DV) were significantly higher in the femtosecond group (p = 0.022 and < 0.001). The overcorrection ratios were 48.8% in the conventional and 58.9% in the femtosecond group. (p < 0.001). For patients with TIA over 0.75 D, SIA and correction index (TIA into SIA) was higher in femtosecond group (0.310 and 0.250, p < 0.001 and < 0.001, respectively). Absolute angle of error was 20.612 ± 18.497 in the femtosecond group and higher than the conventional group (2.778, p = 0.010).

Conclusion

Femtosecond laser arcuate keratotomy in cataract surgery was effective in SIA between 0.75 to 3.00 D of corneal astigmatism. However, the overcorrection in the lower astigmatism and angle of error in the higher astigmatism were due to the postoperative corneal astigmatism not decreasing as much as SIA. Overcoming these challenges will lead to better management of corneal astigmatism.

SUBMITTER: Ahn H

PROVIDER: S-EPMC9453263 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Publications

Femtosecond laser-assisted arcuate keratotomy for the management of corneal astigmatism in patients undergoing cataract surgery: Comparison with conventional cataract surgery.

Ahn Hyunmin H Jun Ikhyun I Seo Kyoung Yul KY Kim Eung Kweon EK Kim Tae-Im TI

Frontiers in medicine 20220825

<h4>Purpose</h4>To assess the effects of femtosecond laser arcuate keratotomy with femtosecond laser-assisted cataract surgery in the management of corneal astigmatism, compared with conventional phacoemulsification cataract surgery.<h4>Design</h4>Retrospective comparative interventional case series.<h4>Methods</h4>A total of 2,498 eyes of consecutive patients who presented with 3.00 diopters (D) or under of astigmatism were included. The patients were treated with conventional phacoemulsificati ...[more]

PMID: 36091670

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Project description:ImportanceAfter cataract surgery, postoperative residual astigmatism can influence a patient's visual quality and satisfaction. Finding ways to minimize this astigmatism is important.ObjectiveTo compare the clinical outcomes of femtosecond laser arcuate keratotomy (FSAK) and toric intraocular lens (TIOL) implantation for astigmatism correction in patients undergoing femtosecond laser-assisted cataract surgery.Design, setting, and participantsThis randomized clinical trial was conducted between October 2021 and September 2023 at the Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, China. Patients with mild to moderate regular corneal astigmatism ranging from 0.75 diopters (D) to 3.00 D were recruited.InterventionsPatients were randomly assigned in a 1:1 ratio to receive FSAK or TIOL implantation.Main outcomes and measuresThe primary outcome was the subjective manifest refraction assessed at 3 months postoperatively.ResultsA total of 196 patients (mean [SD] age, 68.4 [13.7] years; 124 female [63%]) were randomized to the FSAK group (98 [50%]) or TIOL group (98 [50%]), and 92 patients (94%) and 95 patients (97%), respectively, finished the 3-month follow-up. At 3 months postoperatively, there was no difference in the refractive astigmatism between the 2 groups (mean [SD], 0.64 [0.64] D vs 0.54 [0.55] D; difference, 0.11 D; 95% CI, -0.06 to 0.27 D; P = .21). The mean (SD) uncorrected distance visual acuity was 0.15 (0.20) logMAR (Snellen equivalent, 20/28) for the FSAK group and 0.14 (0.19) logMAR (Snellen equivalent, 20/28) for the TIOL group (difference, 0.01 D; 95% CI, -0.04 to 0.06 D; P = .71). Subgroup analyses showed that TIOL implantation achieved lower residual astigmatism compared with FSAK when treating astigmatism exceeding 1.5 D or against-the-rule astigmatism.Conclusions and relevanceResults of this randomized clinical trial demonstrate that in study participants with mild to moderate astigmatism undergoing femtosecond laser-assisted cataract surgery, FSAK was not superior to TIOL implantation for astigmatism correction. However, for astigmatism exceeding 1.5 D or against-the-rule astigmatism, TIOL implantation demonstrated greater efficacy over FSAK. Future trials are needed to determine if there is greater efficacy of TIOL implantation over FSAK as suggested by subgroup analyses.Trial registrationChiCTR.org.cn Identifier: ChiCTR2100051066.

Project description:PurposeThe aim of this study was to assess the effectiveness of the Verion-LenSx guided arcuate incision technique to reduce refractive astigmatism in a pseudophakic population.Patients and methodsA prospective single-arm study was conducted in which one or both eyes of subjects required reduction of 1.0-2.0 D of refractive astigmatism after previous cataract surgery or refractive lens exchange. The surgeon used the refractive cylinder in the eye and the Woodcock astigmatism nomogram for preoperative planning, while the LenSx femtosecond laser with the Verion Image Guided System was used to create all arcuate incisions. The primary outcome measure was the uncorrected monocular distance visual acuity (UCVA). Secondary outcome measures included the change in corneal astigmatism, the change in refractive astigmatism, the best-corrected visual acuity and spectacle independence at distance from preoperative stage to 1 month and 2 months postoperatively.ResultsTwenty-eight eyes of 18 subjects were treated. The best-corrected visual acuity at the 2-month postoperative (PO) stage was not statistically significantly different from the preoperative visual acuity (0.02 logarithm of the minimum angle of resolution [logMAR] in both cases, P>0.05). Uncorrected visual acuity was statistically significantly better at the 2-month PO stage relative to the preoperative value (0.14 versus 0.34 logMAR, P<0.01). The mean change in refractive cylinder from the preoperative stage to the 2-month PO stage was 1.0 D. At the 2-month PO stage, two-thirds of the subjects (12/18) reported that they did not use glasses for distance vision and that their spectacle use for distance vision at 2 months was "lower" or "much lower" than the preoperative stage; in 71% of eyes (20/28), the residual refractive cylinder was ≤0.50 D. Vector changes in keratometric astigmatism were weakly associated with changes in refractive cylinder.ConclusionArcuate incisions made with a femtosecond laser to treat moderate levels of residual refractive astigmatism after previous cataract surgery may reduce dependence on spectacles for distance vision.

Project description:IntroductionAstigmatism reduces the postoperative visual performance after non-toric intraocular lenses (IOLs) implantation, and limits the use of refractive IOLs in cataract surgery. The purpose of this study was to compare the efficacy in astigmatism correction and the postoperative visual outcomes between the implantation of a trifocal IOL with femtosecond laser-assisted arcuate keratotomy (FSAK) in one eye and a bifocal toric IOL (TIOL) in the other, in patients with cataract and moderate astigmatism.MethodsThis prospective observational paired-eye study enrolled patients with cataract and corneal astigmatism (CA) between 0.75 and 2.25 D in both eyes. The patients underwent a mix-and-match treatment comprising trifocal IOL implantation with FSAK and bifocal TIOL implantation. We compared the visual acuity (VA) at all distances, defocus curve, postoperative refractive astigmatism (RfA), CA, high-order aberrations, modulation transfer function (MTF) curve, and Strehl ratio between the two eye groups.ResultsIn total, 41 patients (82 eyes) were enrolled and completed a 6-month follow-up. The 1- and 3-month uncorrected distance VA and 3-month uncorrected near VA were greater in eyes with bifocal TIOLs than with trifocal IOLs and FSAK (p = 0.036, 0.010, and 0.030, respectively), whereas the latter had greater uncorrected intermediate VA at every visit and greater VA in the intermediate range of defocus curve (at -1.50 and - 2.00 D) than the eyes with bifocal TIOLs. The postoperative RA of the eyes with trifocal IOL and FSAK was significantly higher than that of the bifocal TIOL-implanted eyes at the 3- and 6-month follow-ups.DiscussionBoth FSAK and TIOL implantation effectively reduce pre-existing moderate astigmatism in patients with cataract. The eyes with bifocal TIOLs had more stable long-term astigmatism correction, whereas those with trifocal IOLs and FSAK had better intermediate VA. Therefore, a mix-and-match implantation of trifocal IOL with FSAK and contralateral bifocal TIOL could achieve effective astigmatism correction and provide an overall optimal VA.

Project description:PurposeTo compare the relative effectiveness of Verion-LenSx guided femtosecond arcuate incisions and manual incisions in reducing postoperative refractive astigmatism.Patients and methodsThis was a contralateral eye, prospective study that included subjects with 0.50 D to 1.75 D of corneal astigmatism who wanted less refractive astigmatism post cataract surgery. The surgeon used anterior keratometry and the Woodcock astigmatism nomogram for preoperative planning, while the LenSx femtosecond laser with the Verion Image Guided System was used to create all laser arcuate incisions. Manual incisions were planned using the Donnenfeld nomogram and made with a fixed-depth diamond knife. The primary outcome measure was the residual refractive astigmatism at 3 months postoperative. Secondary outcome measures included the manifest refraction, uncorrected distance visual acuity and the change in corneal astigmatism from 1 to 3 months postoperative.ResultsForty-one subjects were successfully enrolled in the study, with data from 38 subjects available at 3 months. There were no statistically significant differences in refractive astigmatism, corneal astigmatism, uncorrected distance visual acuity or manifest refraction between the Manual and Femto groups at either 1 month or 3 months. Significant changes in refractive and corneal astigmatism were noted between 1 months and 3 months. Ninety percent of eyes in both groups had ≤0.50 D of refractive astigmatism at 3 months. Two minor non-serious adverse events (full-thickness incisions of the cornea) occurred in two eyes of two different subjects in the Manual group; they were resolved without incident.ConclusionLaser arcuate incisions appear to be an effective means of reducing postoperative refractive astigmatism at the time of cataract surgery. No significant clinical differences were observed between incisions made manually and those made with an image-guided femto-second laser system. The lower number of minor adverse events experienced with the femtosecond laser system is an apparent advantage.

Dataset Information

Femtosecond laser-assisted arcuate keratotomy for the management of corneal astigmatism in patients undergoing cataract surgery: Comparison with conventional cataract surgery.

Purpose

Design

Methods

Results

Conclusion

Publications

Femtosecond laser-assisted arcuate keratotomy for the management of corneal astigmatism in patients undergoing cataract surgery: Comparison with conventional cataract surgery.

Similar Datasets

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