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Femtosecond arcuate keratotomy advantageous in astigmatic correction
Compared to manual limbal relaxing incisions performed in conventional phacoemulsification cataract surgery, nonpenetrating femtosecond laser arcuate keratotomy performed during femtosecond laser-assisted cataract surgery can achieve an astigmatic correction of greater magnitude, according to a study.
The randomized controlled trial compared the results of 400 patients who underwent cataract surgery, of which 200 were operated with conventional phacoemulsification and 200 with femtosecond laser-assisted cataract surgery. Fifty-one eyes of 51 patients in the phacoemulsification group underwent LRI, and 53 in the femtosecond laser-assisted group underwent femtosecond arcuate keratotomy. Seventeen patients from the two subgroups were excluded from further analysis because of visual comorbidities. All postoperative results were recorded at 4 weeks’ follow-up.
Eight LRI patients (20%) and 18 femtosecond arcuate keratotomy patients (44%) attained a postoperative cylinder of less than 0.50 D, and 18 patients (44%) vs. 32 patients (74%) attained less than 1.00 D of cylinder. The mean corneal astigmatism was reduced from 1.38 D to 0.89 D in the femtosecond arcuate keratotomy group and from 1.50 D to 1.17 D in the LRI group.
“[B]oth manual LRIs and femtosecond laser intrastromal arcuate keratotomies were safe and easy to perform, with both achieving a meaningful reduction in corneal astigmatism. However, the laser group achieved a correction of greater magnitude than the LRI cohort 4 weeks after surgery,” the authors wrote. – by Michela Cimberle
Disclosure: Roberts reports no relevant financial disclosures. Please see the study for the other authors’ financial disclosures.
Perspective
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This study suggests that intrastromal arcuates from femto are more predictable and accurate than LRIs in low astigmatism. Low astigmatism is generally pretty forgiving; however, only 20% of the LRI patients in this series were within 0.5 D of residual astigmatism, which is an unusually low proportion. It seems like the LRI category underperformed compared to prior data, so a bigger and longer study would be helpful to see if results are repeatable and sustained. Also, a study including low power toric IOLs in the comparison would help guide clinicians to the best options for astigmatism correction.