Long-term Results of Arcuate Keratotomy in Femtosecond Laser-assisted Cataract Surgery

Chan Woo Bang; Jae Won Choi; Sang Youp Han

doi:10.3341/jkos.2019.60.10.946

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Bang, Choi, and Han: Long-term Results of Arcuate Keratotomy in Femtosecond Laser-assisted Cataract Surgery

Original Article

Journal of the Korean Ophthalmological Society 2019; 60(10): 946-952.

Published online: 21 October 2019

DOI: https://doi.org/10.3341/jkos.2019.60.10.946

Long-term Results of Arcuate Keratotomy in Femtosecond Laser-assisted Cataract Surgery

Chan Woo Bang, MD, Jae Won Choi, MD, Sang Youp Han, MD

Sungmo Eye Hospital, Busan, Korea.

Address reprint requests to Sang Youp Han, MD. Sungmo Eye Hospital, #409 Haeun-daero, Haeundae-gu, Busan 48064, Korea. Tel: 82-51-743-0775, Fax: 82-51-743-0776, medicalhan@daum.net

Received 7 February 2019 Revised 2 April 2019 Accepted 24 September 2019

The Korean Ophthalmological Society

(open-access):

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 investigate the long-term follow-up results of arcuate keratotomy in femtosecond laser-assisted cataract surgery.

Methods

The medical records of 78 patients (99 eyes) with corneal astigmatism >0.5 diopters (D) who underwent arcuate keratotomy concurrent with femtosecond laser-assisted cataract surgery were retrospectively reviewed. Uncorrected and corrected visual acuities and keratometric and higher order aberration outcomes were compared preoperatively and 2 years postoperatively.

Results

The mean uncorrected visual acuities and corrected visual acuities changed from 0.55 ± 0.31 D and 0.33 ± 0.26 D, preoperatively to 0.13 ± 0.19 D and 0.07 ± 0.09 D, 2 years postoperatively. The mean preoperative corneal astigmatism was −1.15 ± 0.66 D. This was reduced to −0.79 ± 0.38 D at 1–2 days after surgery (p < 0.001), followed by no significant change for 2 years. The mean target-induced astigmatism was 1.15 ± 0.66 D preoperatively, and the mean surgically-induced astigmatism and difference vector were 0.69 ± 0.43 D and 0.83 ± 0.48 D, 2 years postoperatively. The mean correction index was 0.68 ± 0.45, 2 years postoperatively. There was no significant difference in higher order aberrations except 4 mm and 6 mm total higher order aberrations and 6 mm trefoil between preoperatively and 2 years postoperatively.

Conclusions

Arcuate keratotomy concurrent with femtosecond laser-assisted cataract surgery is a safe and effective way to reduce corneal astigmatism which remained stable over 2 years of follow-up with below moderate astigmatism.

Keywords: Arcuate keratotomy, Astigmatism, Corneal cylinder, Femtosecond laser, Higher order abberation

Figures and Tables

Figure 1

Preoperative and postoperative UCVA (logarithm of minimal angle of resolution, logMAR) and BCVA (logMAR) with standard deviation. Large improvement was shown at 1–2 days and maintained without significant change for 2 years. UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; Preop. = preoperative; mo = months; yr(s) = year(s).

Figure 2

Preoperative and postoperative corneal astigmatism (diopter) with standard deviation. Significant improvement was shown at 1–2 days and maintained without significant change for 2 years. Wilcoxon signed rank test was used to examine statistical difference. Preop = preoperative; mo = month; yr = year; yrs = years; cyl = corneal astigmatism. ^*Significant difference between preoperation and postoperation 1-2 days.

Figure 3

Distribution of corneal astigmatism at preoperative and postoperative 2 years. Rate of patients below 1.0 diopter increased at 2 years after surgery. Preop. = preoperation; Postop. = postoperation; yrs = years; D = diopter.

Figure 4

Scatterplot of corneal astigmatism change. Scattered dots gathered within 1.0 diopter at 2 months after surgery. Preop. = preoperation; cyl = corneal astigmatism; mon = months; D = diopter.

Figure 5

Scatterplot of corneal astigmatism change. Similar distribution can be seen between 2 months and 2 years. mon = months; yr = years; cyl = corneal astigmatism; D = diopter.

Table 1

Demographics of patients

Values are presented as mean ± standard (range) or number.

UCVA = uncorrected visual acuity; logMAR = logarithm of minimal angle of resolution; BCVA = best corrected visual acuity; D = diopter.

Table 2

Preoperative and postoperative visual acuity (logMAR)

Values are presented as mean ± standard deviation.

logMAR = logarithm of minimal angle of resolution; UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; SD = standard deviation.

^*Wilcoxon signed rank test.

Table 3

Preoperative and postoperative corneal astigmatism

Values are presented as mean ± standard deviation unless otherwise indicated.

D = diopter; SD = standard deviation.

^*Wilcoxon signed rank test.

Table 4

Vector analysis using Alphins method of keratometric astigmatic correction at 2 years after femtosecond-assisted combined phacoemulsification and arcuate keratotomy

Values are presented as mean ± standard (range).

D = diopter; TIA = target induced astigmatism; SIA = surgically induced astigmatism; DV = difference vector; CI = correction index; SD = standard deviation.

^*Student's t-test.

Table 5

The comparison of higher order abberations between preoperation and postoperation (2 months) after femtosecond-assisted combined phacoemulsification and arcuate keratotomy

Values are presented as mean ± standard deviation.

tHOA = total higher order abberations.

^*Wilcoxon signed rank test.

Table 6

The comparison of higher order abberations between 2 months and 2 years after femtosecond-assisted combined phacoemulsification and arcuate keratotomy

Values are presented as mean ± standard deviation.

tHOA = total higher order abberations.

^*Wilcoxon signed rank test.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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