Safety and efficacy of femtosecond laser–assisted arcuate keratotomy to treat irregular astigmatism after penetrating keratoplasty

Fadlallah, Ali; Saragoussi, J J; Chelala, Elias; Amari, Belkacem; Legeais, Jean‐Marc

doi:10.1016/j.jcrs.2014.08.046

Cited by 34 publications

(44 citation statements)

References 30 publications

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“…Improvement of the UCVA and BCVA after the combined procedure was observed in the present study in comparison with the results of femtosecond laser-assisted AK for the treatment of high-astigmatism post-PKP reported by Cleary et al (22) and Fadlallah et al (23). In the present study, the mean UCVA improved from 0.95±0.24 LogMAR pre-operatively to 0.61±0.17 LogMAR postoperatively (P<0.05).…”

Section: Discussionsupporting

confidence: 78%

Effects of astigmatic keratotomy combined with scleral tunnel incisions for the treatment of high astigmatism after penetrating keratoplasty

et al. 2018

Exp Ther Med

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The present study aimed to evaluate the efficacy, predictability and safety of astigmatic keratotomy (AK) combined with scleral tunnel incisions in the treatment of high astigmatism after penetrating keratoplasty (PKP). Paired AK combined with scleral tunnel incisions was performed at the steep astigmatic meridian in 8 eyes of 8 patients with high keratometric astigmatism [>5.0 diopters (D)] after PKP. Pre-and post-operative parameters, including uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction and keratometric astigmatism were evaluated. The Alpins method for vector analysis was used to evaluate the changes in keratometric astigmatism. The results indicated a statistically significant reduction in the mean keratometric astigmatism from 8.16±3.02 D pre-operatively to 2.28±1.07 D at 3 months postoperatively. The mean UCVA improved from 0.95±0.24 logarithm of the minimum angle of resolution (logMAR) pre-operatively to 0.61±0.17 logMAR at 3 months postoperatively (P<0.05). The mean BCVA improved from 0.41±0.18 logMAR pre-operatively to 0.26±0.12 logMAR at 3 months postoperatively (P>0.05). Between 3 and 6 months after the surgery, the keratometric astigmatism remained stable. Alpins vector analysis demonstrated the relative predictability of this combined surgical treatment. The surgically induced astigmatism was significantly correlated with the target induced astigmatism (r= 0.76, P<0.05). None of the patients had any severe complications. The present study indicated that AK combined with scleral tunnel incisions is an effective, relatively predictable and safe treatment for high astigmatism after PKP.

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Section: Discussionsupporting

confidence: 78%

Effects of astigmatic keratotomy combined with scleral tunnel incisions for the treatment of high astigmatism after penetrating keratoplasty

et al. 2018

Exp Ther Med

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“…Comparable to our study, Löffler et al [8] have recently reported a reduction of the magnitude of anterior corneal astigmatism in a prospective study enrolling 27 healthy corneas undergoing penetrating femtosecond laser-assisted keratotomy, with minimal effect on the magnitude of posterior corneal astigmatism. Chan et al [11] The reduction in corneal topographic astigmatism was associated with a reduction in refractive cylinder, as observed in other studies evaluating the effect of femtosecond-assisted ISAK in virgin [13], post-refractive surgery [18], and post-keratoplasty corneas [9] [10] [15]. Day and colleagues [13] found in a prospective case series including 196 eyes undergoing femtosecond laser-assisted ISAK that 0% of the eyes had a refractive cylinder of 0.50 D or less preoperatively, with an increase to 32.1% postoperatively.…”

Section: Discussionmentioning

confidence: 81%

“…In the current study, we have demonstrated that non-penetrating femtosecond laser-assisted ISAK is effective not only in terms of corneal topographic , but also after refractive surgery [18] or even in post-keratoplasty corneas with high levels of associated astigmatism [9] [10] [14] [15]. Comparable to our study, Löffler et al [8] have recently reported a reduction of the magnitude of anterior corneal astigmatism in a prospective study enrolling 27 healthy corneas undergoing penetrating femtosecond laser-assisted keratotomy, with minimal effect on the magnitude of posterior corneal astigmatism.…”

Section: Discussionmentioning

confidence: 99%

Non-Penetrating Femtosecond Laser Intrastromal Astigmatic Keratotomy Performed during Laser-Assisted Cataract Surgery: Results on Keratometric Astigmatism

Kaczmarek¹,

Brockmann²,

Laube³

2017

OJOph

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Purpose: To investigate the efficacy of non-penetrating femtosecond laser intrastromal astigmatic keratotomy (ISAK) in terms of topographic and refractive changes. Methods: Retrospective study including 42 eyes (35 patients) with a corneal astigmatism between 0.5 and 1.5 D. All eyes underwent femtosecond laser-assisted cataract surgery with ISAK for astigmatism management using the Catalys laser system (Johnson & Johnson Vision). Visual acuity, refraction, as well as corneal topographic and corneal endothelial cell density (ECD) changes were evaluated during a 12-month follow-up. Astigmatic changes were analyzed using the Alpins vector method. Results: A significant reduction in manifest cylinder was observed at 1 month postoperatively (p = 0.03), with no significant changes afterwards (p = 0.90). A total of 38.1%, 52.4% and 59.2% of eyes had a manifest cylinder of 0.50 D or lower preoperatively and at 1 and 12 months after surgery, respectively. A significant reduction was found in topographic astigmatism at 1 month postoperatively (p < 0.01), with an additionally small but statistically significant reduction afterwards (p < 0.01). No significant changes in postoperative uncorrected (p = 0.97) and corrected visual acuities (p = 0.40) were observed during the follow-up. There was a trend to undercorrection of corneal astigmatism that decreased significantly over time. This led to some variability in changes of refractive astigmatism. A small but significant reduction in ECD was observed at 1 month postoperatively (p < 0.01), with no significant changes afterwards. Conclusions: Femtosecond laser assisted ISAK is an effective and safe option to reduce corneal astigmatism during cataract surgery and consequently refractive astigmatism.

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“…27 Recently, many authors reported better results using femtosecond laser technology with AK. [29][30][31] Loriaut et al 29 reported a mean CI of 0.9 of femtosecond-assisted AK in post-keratoplasty astigmatism, but 50% of eyes were overcorrected. Although the CI of FTAK was 0.63 in our study, only 3 eyes (4%) were overcorrected with FTAK, including 2 eyes that were overcorrected by less than 0.5 D (Fig.…”

Section: Discussionmentioning

confidence: 99%

Two-Year Outcomes After Full-Thickness Astigmatic Keratotomy Combined with Small-Incision Lenticule Extraction for High Astigmatism

Kim

Chung

2020

Preprint

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Purpose: To evaluate clinical outcomes after full-thickness astigmatic keratotomy (FTAK) combined with small-incision lenticule extraction (SMILE) in eyes with high astigmatism.Methods: This study comprised 75 eyes of 43 patients with over 4.0 diopters (D) of astigmatism who were treated with SMILE after FTAK. Visual acuities and refractive measurements were evaluated at 1 month after FTAK, and 1, 6, 12, and 24 months after SMILE. Vector analysis of the astigmatic changes was performed using the Alpins method.Results: Twenty-four months after the combined procedure, the average spherical equivalent was reduced from -6.56 ± 2.38 D to -0.36 ± 0.42 D (p < 0.001). The uncorrected and corrected distance visual acuities improved from 1.54 ± 5.53 to -0.02 ± 0.09 and from -0.03 ± 0.07 D to -0.07 ± 0.08 D (both p < 0.001), respectively. The preoperative mean astigmatism was -5.48 ± 1.17 D, which was reduced to -2.27 ± 0.97 D and -0.34 ± 0.26 D at 1 month after FTAK and 24 months after SMILE, respectively (p <0.001). The surgically-induced astigmatism after FTAK, SMILE, and FTAK and SMILE combined was 3.38 ± 1.18 D, 2.22 ± 0.84 D, and 5.39 ± 1.20 D, respectively. Furthermore, the correction index of FTAK, SMILE, and FTAK and SMILE combined was 0.63 ± 0.17, 0.90 ± 0.40, and 0.98 ± 0.06, respectively. There were no intraoperative or postoperative complications. Conclusion: Our surgical procedure combining FTAK and SMILE showed good and stable clinical outcomes during two-year follow-up for the treatment of high astigmatism.

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Safety and efficacy of femtosecond laser–assisted arcuate keratotomy to treat irregular astigmatism after penetrating keratoplasty

Abstract: No author has a financial or proprietary interest in any material or method mentioned.

Cited by 34 publications

References 30 publications

Effects of astigmatic keratotomy combined with scleral tunnel incisions for the treatment of high astigmatism after penetrating keratoplasty

Effects of astigmatic keratotomy combined with scleral tunnel incisions for the treatment of high astigmatism after penetrating keratoplasty

Non-Penetrating Femtosecond Laser Intrastromal Astigmatic Keratotomy Performed during Laser-Assisted Cataract Surgery: Results on Keratometric Astigmatism

Two-Year Outcomes After Full-Thickness Astigmatic Keratotomy Combined with Small-Incision Lenticule Extraction for High Astigmatism

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