Search citation statements
Paper Sections
Citation Types
Year Published
Publication Types
Relationship
Authors
Journals
Purpose To analyze different tomographic and refractive parameters for predicting successful visual outcome following femtosecond laser-assisted arcuate keratotomy (FSAK) for post-keratoplasty astigmatism. Design Retrospective. Methods Retrospective study evaluating patients with astigmatism following penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK) who underwent FSAK. Vector analysis using the Alpins method was done to calculate surgically induced astigmatism (SIA). An improvement of 3 lines of Early Treatment Diabetic Retinopathy Study (ETDRS) lines was used for successful outcome. Outcome was measured at 3 months and 17 months. Results This study included 106 eyes from 104 patients (65 males and 39 females). Mean age was 31.8±8.6 years, and 89.4% ( n =93) of cases were keratoconus (KC), 3.8% ( n =4) scar, 3.8% ( n =4) granular dystrophy, 1.9% ( n =2) post-LASIK ectasia, and 1.0% ( n =1) macular dystrophy. Uncorrected visual acuity (UCVA) improved from 1.02±0.53 logarithm minimal angle of resolution (logMAR) to 0.87±0.49 logMAR ( p =0.01) at 3 months and to 0.92±1.08 logMAR ( p =0.57) at 17 months. Best spectacle-corrected visual acuity (BSCVA) improved from 0.41±0.30 logMAR to 0.31±0.19 logMAR ( p <0.01) at 3 months and to 0.23±0.27 logMAR ( p <0.01) at 17 months. Success was achieved in 50% ( n =53) and 49% ( n =52) at 3 and 17 months follow-up, respectively. Success group showed worse preoperative UCVA (1.21±0.56 vs 0.83±0.44 logMAR; p <0.01), worse preoperative BSCVA (0.50±0.36 vs 0.33±0.19 logMAR; p =0.01). Preoperative UCVA had an area under the curve of 0.721 (95% CI: 0.622–0.820; p < 0.01). The Youden’s optimal cutoff point was 0.90 logMAR (equivalent Snellen 20/159) with 76.9% sensitivity and 35.2% specificity. Flattening index (FI) was 87% in DALK and 73% in PKP ( p =0.14). Correction index (CI) was 99% and 86% ( p =0.18) for DALK and PKP, respectively. Success of the astigmatic surgery for DALK and PKP was 44% vs 42% ( p =0.29), respectively. Conclusion Improvement of at least three lines was achieved in 49% of patients who underwent FSAK following PKP or DALK; this improvement was achieved in patients who had a worse preoperative UCVA.
Purpose To analyze different tomographic and refractive parameters for predicting successful visual outcome following femtosecond laser-assisted arcuate keratotomy (FSAK) for post-keratoplasty astigmatism. Design Retrospective. Methods Retrospective study evaluating patients with astigmatism following penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK) who underwent FSAK. Vector analysis using the Alpins method was done to calculate surgically induced astigmatism (SIA). An improvement of 3 lines of Early Treatment Diabetic Retinopathy Study (ETDRS) lines was used for successful outcome. Outcome was measured at 3 months and 17 months. Results This study included 106 eyes from 104 patients (65 males and 39 females). Mean age was 31.8±8.6 years, and 89.4% ( n =93) of cases were keratoconus (KC), 3.8% ( n =4) scar, 3.8% ( n =4) granular dystrophy, 1.9% ( n =2) post-LASIK ectasia, and 1.0% ( n =1) macular dystrophy. Uncorrected visual acuity (UCVA) improved from 1.02±0.53 logarithm minimal angle of resolution (logMAR) to 0.87±0.49 logMAR ( p =0.01) at 3 months and to 0.92±1.08 logMAR ( p =0.57) at 17 months. Best spectacle-corrected visual acuity (BSCVA) improved from 0.41±0.30 logMAR to 0.31±0.19 logMAR ( p <0.01) at 3 months and to 0.23±0.27 logMAR ( p <0.01) at 17 months. Success was achieved in 50% ( n =53) and 49% ( n =52) at 3 and 17 months follow-up, respectively. Success group showed worse preoperative UCVA (1.21±0.56 vs 0.83±0.44 logMAR; p <0.01), worse preoperative BSCVA (0.50±0.36 vs 0.33±0.19 logMAR; p =0.01). Preoperative UCVA had an area under the curve of 0.721 (95% CI: 0.622–0.820; p < 0.01). The Youden’s optimal cutoff point was 0.90 logMAR (equivalent Snellen 20/159) with 76.9% sensitivity and 35.2% specificity. Flattening index (FI) was 87% in DALK and 73% in PKP ( p =0.14). Correction index (CI) was 99% and 86% ( p =0.18) for DALK and PKP, respectively. Success of the astigmatic surgery for DALK and PKP was 44% vs 42% ( p =0.29), respectively. Conclusion Improvement of at least three lines was achieved in 49% of patients who underwent FSAK following PKP or DALK; this improvement was achieved in patients who had a worse preoperative UCVA.
Visual rehabilitation after a keratoplasty is often compromised due to high amounts of residual astigmatism. Femtosecond laser-assisted astigmatic keratotomy (FLAK) is gaining popularity in decreasing this astigmatism. Though one set of two incisions suffices in most cases, sometimes the treatment proves insufficient and additional treatment is required. This case series evaluates the outcomes in patients who underwent two consecutive FLAK sets to correct post-keratoplasty residual astigmatism. All repeated FLAK cases performed on post-keratoplasty eyes were reviewed in a high-volume clinic as a non-comparative retrospective case series. The data extracted include the procedure parameters, time between procedures, refraction including sphere, astigmatism, spherical equivalent (SE), and uncorrected and best-spectacle-corrected distance visual acuity (UDVA, BSDVA, respectively). Eleven eyes of eleven patients aged 25.5 ± 10 treated with more than one FLAK procedure were identified. The average follow-up time was 6 months after the first FLAK and 24 ± 10 months after the second. The second FLAK was performed six months after the first. The preoperative mean astigmatism was −9.59 ± 2.36 D. At the final follow-up, the mean astigmatism decreased to −5.38 ± 1.79 D (p = 0.001). Repeated FLAK procedures achieved a significant and stable reduction of astigmatism in post-keratoplasty eyes. This procedure shows safety and effectivity in these complex eyes and may prevent the need for a further keratoplasty.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.