JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2016.57.3.353 jkos-57-353 Original Article Clinical Outcomes of Combined Procedure of Astigmatic Keratotomy and Laser in situ Keratomileusis KimBu KiMD MunSu JoungMD, PhD LeeDae GyuMD, PhD ChungYoung TaekMD, PhD Onnuri Smile Eye Clinic, Seoul, Korea Address reprint requests to Young Taek Chung, MD, PhD, Onnuri Smile Eye Clinic, #1 Gangnam-daero 65-gil, Seocho-gu, Seoul 06614, Korea, Tel: 82-2-6913-0000, Fax: 82-2-532-5406, E-mail: ytchungc@hanmail.net 09 2016 03 09 2016 57 3 353 360 17072015 03122015 16022016 Copyright © 2016 The Korean Ophthalmological Society 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

To evaluate the clinical outcomes of a combined procedure of astigmatic keratotomy (AK) and laser in situ keratomileusis (LASIK) for the correction of high astigmatism.

 Methods

Thirty-five eyes of 19 patients who had astigmatic keratotomy were studied. The patients had a secondary procedure, LASIK, to correct the residual refractive error. Follow-up visits were at 1 week, 1 month, 3 months, and 6 months. The outcome measures included uncorrected distance visual acuity, refractive error, efficacy, safety, and predictability. We compared preoperative and post-AK expected corneal ablation depth using an Amaris Ablation depth table.

 Results

After astigmatic keratotomy, astigmatism was reduced by 61.43 ± 14.62%, and after LASIK, astigmatism was reduced by 91.65 ± 8.68%. Expected corneal ablation depth was reduced by 18.72 ± 11.77% after astigmatic keratotomy. The proportion of eyes with spherical equivalent 0.5 D or less was 85.71% at 6 months after the combined procedure of astigmatic keratotomy and LASIK. No intraoperative or postoperative complications were observed.

 Conclusions

This study showed the combined procedure of astigmatic keratotomy and LASIK is effective for visual acuity, refraction, and reduction in corneal ablation depth.

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Astigmatic keratotomy. (A) Corneal marking using a ring marker with cross wires (7.5 mm). (B) Marking at the 3, 6, 9, and 12 o'clock directions using a marking pen. (C) Beveled, full thickness cornea incision with a 2.8 mm blade at the steepest axis. (D) Extension of corneal incision with a wider blade. (E) Checking of leakage with a W eck-Cel sponge. (F) Subconjunctival injection with a mixture of antibiotics, steroid, and lidocaine.

Changes in UDVA and CDVA after astigmatic keratotomy and LASIK. UDVA = uncorrected distance visual acuity; CDVA = corrected distance visual acuity; LASIK = laser in situ keratomileusis; Preop = preoperation; AK = astigmatic keratotomy.

Changes in spherical equivalent and astigmatism after astigmatic keratotomy and LASIK. LASIK = laser in situ keratomileusis; Preop = preoperation; AK =astigmatic keratotomy.

Vector analysis of astigmatism. This polar plot shows the reduction in astigmatism after astigmatic keratotomy and LASIK. Dark gray dots (after AK) are closer to the center com pared to black dots (preoparetive), and bright gray dots (after LASIK) are more closer to the center. LASIK = laser in situ keratomileusis; Preop = preoperation; AK =astigmatic keratotomy.

Stability of the combined procedure of astigmatic keratotomy and LASIK. Spherical equivalent refraction after combined procedure is sTable for 6 months. LASIK = laser in situ keratomileusis; Preop = preoperation; AK =astigmatic keratotomy.

Predictability of the combined procedure of astigmatic keratotomy and LASIK. Scatterplot of the attempted spherical equivalent refractive change plotted against the achieved spherical equivalent change at 6 months. LASIK = laser in situ keratomileusis.

Safety of the combined procedure of astigmatic keratotomy and LASIK. The percentage of eyes in which there was a gain/loss of Snellen visual acuity lines (CDVA). LASIK = laser in situ keratomileusis; CDVA = corrected distance visual acuity.

Nomogram of the beveled, full thickness astigmatic keratotomy

Distance from corneal marking (mm) Incision width (mm) Corrected astigmatism (D)
1.5 2.8 0.75
1.5 4.1 1.25
1.5 5.7 2.5
1.0 2.8 1
1.0 4.1 1.75
1.0 5.7 3
0.5 4.1 2
0.5 5.7 3.5
0 5.7 4.5

Demographics of the patients

Characteristics Data
Eyes (n) 35
Sex (male/female) 17/18
Age (years) 25.05 ± 6.76 (18∼40)
Mean corneal power (diopter) 44.02 ± 2.15 (39.75∼50.0)
UDVA (log MAR) 1.06 ± 0.52 (0.2∼2.0)
CDVA (log MAR) 0.01 ± 0.11 (-0.2∼0.1)
IOP (mm Hg) 14.16 ± 2.39 (10∼18)
Sphere (diopter) −3.46 ± 2.04 (0∼-6.75)
Cylinder (diopter) −4.07 ± 0.90 (-3.0∼-6.0)
Spherical equivalence (diopter) −5.50 ± 1.87 (-2.50∼-9.125)
CCT (μm) 525.46 ± 22.92 (475∼574)
Expected ablation depth (μm) 118.23 ± 24.51 (73∼165)

Values are presented as mean ± SD unless otherwise indicated.

UDVA = uncorrected distance visual acuity; log MAR = logarithm of the minimum angle of resolution; CDVA = corrected distance visual acuity; IOP = intraocular pressure; CCT = central cornea thickness.