Clinical Outcomes of Beveled, Full Thickness Astigmatic Keratotomy

Su Joung Mun; Dae Gyu Lee; Young Taek Chung

doi:10.3341/jkos.2015.56.8.1160

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Mun, Lee, and Chung: Clinical Outcomes of Beveled, Full Thickness Astigmatic Keratotomy

Original Article

J Korean Ophthalmol Soc 2015;56(8):1160-1169.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.8.1160

Clinical Outcomes of Beveled, Full Thickness Astigmatic Keratotomy

Su Joung Mun, M.D., PhD, Dae Gyu Lee, M.D., PhD, Young Taek Chung, M.D., 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 137-855, Korea Tel: 82-2-6913-0000, Fax: 82-2-532-5406 E-mail: ytchungc@daum.net

Received 21 November 201417 March 2015 Accepted 25 June 2015

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 beveled, full thickness astigmatic keratotomy.

Methods

This study included 185 eyes of 112 patients treated with beveled, full thickness astigmatic keratotomy. Treated eyes were divided into 3 groups: beveled, full thickness astigmatic keratotomy after implantable collamer lens (ICL) implantation (group A), beveled, full thickness astigmatic keratotomy after cataract surgery (group B) and beveled, full thickness astigmatic keratotomy alone (group C). Follow-up visits were at 1 week, 1 month, 3 months and 6 months. The outcome measures included uncorrected distance visual acuity, astigmatism, efficacy, safety and predictability.

Results

At 6 months postoperatively, astigmatism was significantly reduced: 68.9 ± 18.24% in total, 69.24 ± 20.76%, in the group A, 67.84 ± 17.56% in the group B and 67.82 ± 13.97% in the group C. The proportion of eyes with astigmatism 1.0 or less was 88.65% in total, 91.49% in the group A, 87.5% in the group B and 70.0% in the group C. Mean improvement in corrected dis-tance visual acuity (CDVA) was 0.56 lines; no eyes lost 2 lines of CDVA after 6 months postoperatively. Postoperative complica-tions were not observed.

Conclusions

This study showed the beveled, full thickness astigmatic keratotomy is effective and safe for correcting astigma-tism alone as well as correcting astigmatism after ICL implantation or cataract surgery.

Keywords: Astigmatic keratotomy, Astigmatism, High astigmatism

References

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Figure 1.

(A) Corneal marking with a ring marker with cross wires (7.5 mm). (B) Making at 3, 9, 12 o’clock direction with marking pen. (C) Beveled, full thickness cornea incision with 2.8 mm blade. (D) Extension of corneal incision with wider blade. (E) Checking the wound with a Weck-Cel sponge if there is any leakage. (F) Subconjunctival injection with mixture of antibiotics, ste-roid, and lidocaine.

Figure 2.

Changes in cylinder after the beveled, full thickness astigmatic keratotomy. Preop = Preoperation.

Figure 3.

(A) Preoperative astigmatism. (B) Postoperative astigmatism at 6 months.

Figure 4.

Predictability. Bar graph represents the percentage of eyes within 0.5D and 1.0D of intended correction at 6 months postoperatively. D = diopters.

Figure 5.

Change in astigmatism from preoperatively. D = diopters.

Figure 6.

Safety. Gain and loss of CDVA 6 months postoperatively. CDVA = corrected distance visual acuity.

Figure 7.

Case example. Beveled full thickness astigmatic keratotomy was performed on the left eye at 12:30 o’clock direction, 5.7-mm width in a patient after ICL implantation. (A) The incision is faintly seen on slit-lamp photography at 1 month post-operatively (dotted line). (B) Kmax was 44.6 D at steep axis on preoperative topography. UCVA was 20/30, CDVA was 20/20, re-fraction was +1.5 -2.75 × 165° preoperatively. (C) At the 1 month postoperative visit, UCVA and CDVA were 20/16, refraction was +0.25 -0.25 × 170°. Kmax was 42.5 D at steep axis. (D) Anterior OCT image of the incision site for ICL implantation. Perpendicular incision can be seen. (E) Anterior OCT image of the incision site for astigmatic keratotomy. Beveled, full thickness incision can be seen. ICL = implantable collamer lens; K = keratometry; UCVA = uncorrected visual acuity; CDVA = corrected distance visual acuity; OCT = optical coherence tomography.

Table 1.

Demographics of patients

Characteristics	Total	Group A	Group B	Group C
Eyes (n)	185	141	24	20
Sex (M/F)	37/75	21/56	7/14	9/5
Age (years)	35.26 ± 16.26	27.1 ± 7.93	61.5 ± 10.94	39.3 ± 13.01
	(18-71)	(18-43)	(47-71)	(21-68)
Mean corneal power (D)	43.44 ± 1.54	43.71 ± 1.22	43.53 ± 2.34	43.63 ± 1.61
	(40.25-48.5)	(40.75-47.75)	(40.25-48.5)	(40.25-47.25)
UDVA (log MAR)	0.24 ± 0.29	0.16 ± 0.13	0.41 ± 0.37	0.66 ± 0.57
	(0-1.0)	(0-0.4)	(0.1-1.0)	(0.1-1.0)
CDVA (log MAR)	-0.06 ± 0.09	-0.09 ± 0.07	0.05 ± 0.11	-0.04 ± 0.06
	(-0.2~0.1)	(-0.2~0.1)	(-0.2~0.1)	(-0.2~0.1)
IOP (mm Hg)	15.07 ± 2.72	15.21 ± 2.62	13.03 ± 2.95	15.65 ± 2.51
	(10-19)	(11-19)	(9-19)	(10-19)
Sphere (D)	0.71 ± 1.41	1.03 ± 0.52	0.38 ± 1.16	-1.3 ± 2.76
	(-5.75~3.0)	(0~2.0)	(-2.25~1.25)	(-5.75~3.0)
Cylinder (D)	-2.24 ± 0.98	-2.12 ± 0.70	-2.6 ± 1.15	-3.31 ± 1.65
	(-8.5~-2.0)	(-5.25~-1.5)	(-6.5~-1.5)	(-8.5~-2.0)
Spherical equivalence (D)	-0.41 ± 1.41	-0.01 ± 0.48	-0.92 ± 1.01	-2.95 ± 3.02
	(-7.75~1.75)	(-0.75~0.87)	(-3.75~0.25)	(-7.75~1.75)

Values are presented as mean ± SD (range) unless otherwise indicated.

D = diopters; UDVA = uncorrected distance visual acuity; CDVA = corrected distance visual acuity; log MAR = log of the minimum angle of resolution; IOP = intraocular pressure.

Table 2.

Changes in UDVA and cylinder after the beveled, full thickness astigmatic keratotomy

Preop		POD
Preop		1 week	1 month	3 months	6 months
UDVA (log MAR)
Total	0.24 ± 0.29	0.08 ± 0.31	0.09 ± 0.30	0.09 ± 0.30	0.09 ± 0.31
		( p < 0.001)	( p < 0.001)	( p < 0.001)	( p < 0.001)
Group A	0.16 ± 0.13	-0.02 ± 0.12	-0.01 ± 0.08	-0.01 ± 0.08	-0.01 ± 0.07
		( p < 0.001)	( p < 0.001)	( p < 0.001)	( p < 0.001)
Group B	0.41 ± 0.37	0.27 ± 0.36	0.27 ± 0.38	0.23 ± 0.38	0.22 ± 0.37
		( p < 0.001)	( p < 0.001)	( p < 0.001)	( p < 0.001)
Group C	0.66 ± 0.57	0.63 ± 0.60	0.61 ± 0.60	0.60 ± 0.59	0.61 ± 0.59
		( p = 0.365)	( p = 0.250)	( p = 0.110)	( p = 0.174)
Cylinder (diopter)
Total	-2.24 ± 0.98	-0.61 ± 0.58	-0.68 ± 0.59	-0.71 ± 0.51	-0.70 ± 0.48
		( p < 0.001)	( p < 0.001)	( p < 0.001)	( p < 0.001)
Group A	-2.12 ± 0.70	-0.54 ± 0.41	-0.64 ± 0.57	-0.69 ± 0.44	-0.64 ± 0.41
		( p < 0.001)	( p < 0.001)	( p < 0.001)	( p < 0.001)
Group B	-2.6 ± 1.15	-0.91 ± 0.98	-0.92 ± 0.58	-0.81 ± 0.66	-0.88 ± 0.63
		( p < 0.001)	( p < 0.001)	( p < 0.001)	( p < 0.001)
Group C	-3.31 ± 1.65	-0.90 ± 0.79	-0.81 ± 0.66	-0.92 ± 0.69	-1.02 ± 0.58
		( p < 0.001)	( p < 0.001)	( p < 0.001)	( p < 0.001)

Values are presented as mean ± SD.

UDVA = uncorrected distance visual acuity; Preop = Preoperation; POD = postoperative day; log MAR = log of the minimum angle of resolution.

Table 3.

Amount of corrected astigmatism at 6 months after as the beveled, full thickness astigmatic keratotomy

	Preop astigmatism (D) P	Postop astigmatism at 6 months (D)	Amount of corrected astigmatism (%)
Total	-2.24 ± 0.98	-0.70 ± 0.48	68.9 ± 18.24
Group A	-2.12 ± 0.70	-0.64 ± 0.41	69.24 ± 20.76
Group B	-2.6 ± 1.15	-0.88 ± 0.63	67.84 ± 17.56
Group C	-3.31 ± 1.65	-1.02 ± 0.58	67.82 ± 13.97

Values are presented as mean ± SD. Preop = preoperation; Postop = postoperation; D = diopters.

Table 4.

Changes in refraction after the beveled, full thickness astigmatic keratotomy

	Astigmatism		SE (D)
	Cylinder (D)	Axis (°)	SE (D)
Preop
Total	-2.24 ± 0.98	139.52 ± 62.46	-0.41 ± 1.41
Group A	-2.12 ± 0.70	146.88 ± 62.45	-0.01 ± 0.48
Group B	-2.6 ± 1.15	102.92 ± 49.54	-0.92 ± 1.01
Group C	-3.31 ± 1.65	138.52 ± 63.02	-2.95 ± 3.02
Postop at 6 months
Total	-0.70 ± 0.48	130.28 ± 61.14	-0.44 ± 1.35
Group A	-0.64 ± 0.41	136.88 ± 61.23	-0.06 ± 0.39
Group B	-0.88 ± 0.63	94.52 ± 51.47	-0.97 ± 1.05
Group C	-1.02 ± 0.58	130.28 ± 59.91	-2.58 ± 3.04

Values are presented as mean ± SD.

D = diopters; SE = spherical equivalence; Preop = preoperation; Postop = postoperation.

Table 5.

Changes in irregularity index checked by ORB^® scan

	3.0 mm zone			5.0 mm zone
	Preop (D)	Postop (D)	p-value	Preop (D)	Postop (D)	p-value
Total	1.55 ± 0.58	1.55 ± 0.78	0.98	2.09 ± 1.13	2.32 ± 1.24	0.04
Group A	1.51 ± 0.51	1.45 ± 0.59	0.35	1.97 ± 0.95	2.13 ± 0.93	0.14
Group B	2.1 ± 1.42	3.41 ± 1.73	0.18	3.78 ± 2.44	5.08 ± 2.62	0.03
Group C	1.78 ± 0.50	1.77 ± 0.26	0.93	2.78 ± 1.20	3.21 ± 1.42	0.52

Values are presented as mean ± SD.

D = diopters; Preop = preoperation; Postop = postoperation.

Table 6.

Changes in CDVA after the beveled, full thickness astigmatic keratotomy and safety index

	Preop CDVA (log MAR)	Postop CDVA at 6 months (log MAR)	p-value	Safety index
Total	-0.06 ± 0.09	-0.11 ± 0.09	<0.01	1.12 ± 0.16
Group A	-0.09 ± 0.07	-0.13 ± 0.06	<0.01	1.11 ± 0.15
Group B	0.05 ± 1.11	0.02 ± 0.10	0.03	1.09 ± 0.18
Group C	-0.04 ± 0.07	-0.12 ± 0.07	<0.01	1.22 ± 0.18

Values are presented as mean ± SD.

CDVA = corrected distance visual acuity; Preop = preoperation; log MAR = log of the minimum angle of resolution; Postop = postoperation.

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