Femtosecond Laser Arcuate Corneal Incisions: Are They Superior to Toric IOLs in Astigmatic Cornea?
Narrative Responses:
Purpose
To present results of laser astigmatic arcuate kertatotomy performed during cataract surgery and compare the results with literature data of astigmatismus management by toric IOLs.
Methods
Laser arcuate incisions were pefromed on steep corneal axis by Victus (Technolas Bausch + Lomb) femtosecond laser on 46 eyes with 3 months follow-up. All patients had refractive astigmatism, K-values, of 0.5D -3,0D, as determined using the autokeratrefractometer (Tonoref II, Nidek). The cataract grade ranged from 0 (where a refractive lens exchange was performed) to grade 5. The arc was positioned at a diameter of 8.5mm and depth was 80%, as pre-determined with pachymetry (Pentacam, Oculus). The AKs were opened directly after the cataract surgery was completed under the surgical microscope.
Results
Astigmatism decreasing from -1.8 ±0.7D preop. to -0.5 ±0.4D. 70% eyes had manifest cylinder of ≤ 0.50D, 83% eyes at ≤ 0.75D and 94% at ≤ 1.0D. Mean post-operative objective cylinder was –0.3 ±0.6D. Similarly, a decrease in mean manifest SEQ was observed, decreasing from 0.2 ±5.5D preoperatively to 0.1 ±1.1D at 3 months postop. Thirteen eyes (27%) had an UDVA of ≥20/20. No patient lost a line of UDVA. The mean corrected distance visual acuity (CDVA) remained quite stable. Twenty three eyes (47%) gained from 1 to 14 lines, 20 eyes (41%) remained stable, and 6 eyes (12%) lost CDVA.
Conclusion
Our initial laser arcuate results are generally comparable with the published data on the correction of astigmatism using toric IOLs and better than published data on manual AKs.