Femtosecond Laser Astigmatic Keratotomy for Management of Post-Keratoplasty Astigmatism

St.Clair, Ryan

Femtosecond Laser Astigmatic Keratotomy for Management of Post-Keratoplasty Astigmatism

Sunday, April 27, 2014: 9:12 AM

Room 151B (Boston Convention and Exhibition Center)

Ryan M. St.Clair, MD, Jules Stein Eye Institute, Los Angeles, CA, USA

Anthony J. Aldave, MD, Jules Stein Eye Institute, Los Angeles, CA, USA

Yakov Goldich, MD, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada

David S. Rootman, MD, FRCSC, University of Toronto, Toronto, ON, Canada

Sonia H. Yoo, MD, Bascom Palmer Eye Institute, Miami, FL, USA

Florence Cabot, MD, Bascom Palmer Eye Institute, Miami, Florida, USA

Jason Jun, MD, MPP BEVERLY HILLS, CA, USA

Fei Yu, PhD, JSEI, UCLA, Los Angeles, CA, USA

Narrative Responses:

Purpose
To determine the safety and effectiveness of femtosecond laser astigmatic keratotomy (FLAK) in the management of post-keratoplasty astigmatism (PKA) and to develop a nomogram to optimize treatment outcomes

Methods
Retrospective review of FLAK procedures performed for PKA between 1/1/2007-8/31/2013 at three academic medical centers. Outcome measures were uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent, topographic astigmatism, and defocus equivalent.

Results
129 FLAK procedures were performed in 127 eyes (124 with prior PK/DALK and 5 with prior DSEK). Mean pre-op, (1 month post-op), and p value for UDVA, CDVA, spherical equivalent, topographic astigmatism and defocus equivalent were: 20/270 (20/155) p<0.0001; 20/56 (20/45) p=0.007; -3.37D (-3.09D) p=0.19; 8.09D (4.39D) p<0.0001; and 7.96D (6.15D) p<0.0001. Corneal endothelial rejection developed in 4 eyes following the procedure, but neither wound dehiscence nor infectious keratitis developed in any eyes. A nomogram for FLAK for management of PKA was created using regression analysis.

Conclusion
FLAK is effective in producing a significant decrease in topographic astigmatism following PK/DALK and DSEK, with a low incidence of associated complications observed in this series. The efficacy of FLAK is expected to improve with the development of a regression-based treatment nomogram.