Optimizing Astigmatism and Refractive Results in Femtosecond Laser-Assisted Cataract Surgery With Multifocal IOL Implantation
Narrative Responses:
Purpose
To compare refraction and keratometric readings before and after phacoemulsification with multifocal intraocular lens (IOL) implantation and placing the main incision at the steepest corneal meridian associated to femtosecond laser arcuate incision
Methods
The main clear corneal incision was placed at the steepest meridian in all cases. Group A: 143 patients (268 eyes) with cataract and corneal astigmatism less than one diopter were retrospectively reviewed from March 2011 to December 2012. A control group of 45 eyes with superior temporal corneal incision for right eyes and superior nasal for left eyes was used for comparison. Group B: 24 patients (44 eyes) with cataract and corneal astigmatism between 0.5 and 1.0 D were prospectively included from August to September 2013. A corneal arcuate incision was performed using femtosecond laser opposite the main incision.
Results
Both near and distance uncorrected visual acuity presented a significant improvement (P<0,01) after implantation of the multifocal IOL (UCVA 20/20 or better in 74.25%, 20/25 or better in 91.04%, and UCNVA J1 in 98.5% of eyes). Keratometric astigmatism decreased after surgery when compared to control group. Mean surgically induced astigmatism was 0.75D ± 0.66. Postoperative spherical equivalent, refractive cylindrical and spherical diopters were significantly reduced after surgery in both groups.
Conclusion
Using the steepest corneal meridian for main incision in phacoemulsification and opposite femtosecond laser arcuate incision with implantation of a multifocal IOL in patients with less than one diopter of astigmatism showed superior performance for final visual acuity.