Combined Femtosecond Laser-Assisted Keratotomy and Cataract Surgery for Enhancing Refractive Outcomes. An Indonesian Case Study

Overview

Journal Clin Ophthalmol

Publisher Dove Medical Press

Specialty Ophthalmology

Date 2023 Oct 16

PMID 37841901

Authors

Viona Viona

Iwan Soebijantoro

Tjahjono D Gondhowiardjo

Affiliations

Soon will be listed here.

Abstract

Purpose: We evaluate the reduction of corneal astigmatism and the improvement of visual outcomes of this surgical method in the Indonesian population. We also assess the accuracy and predictability of using femtosecond laser astigmatic keratotomy (FLAK) combined with cataract surgery.

Patients And Methods: In a retrospective study, a total of 275 subjects (78 with against-the-rule (ATR) astigmatism, 178 with with-the-rule (WTR) astigmatism, and 19 with oblique (OBL) astigmatism) with preexisting corneal astigmatism ranging from 0.75D to 3.00D underwent FLAK. All subjects completed a 3-month follow-up. The femtosecond laser used for creating paired AK 2.2 mm, primary incision, and paracentesis incision was the FEMTO Z8 NEO from Ziemer Ophthalmic System, Switzerland. The surgical approach was guided by the "NAPA" nomogram.

Results: The reduction in postoperative astigmatism was 56.90% for the WTR group, 49.46% for the ATR group, and 47.33% for the oblique group. A significant reduction in astigmatism was observed at the 1-week, 1-month, and 3-month follow-up intervals in both the WTR and ATR groups. The reduction in astigmatism was more favorable in cases of moderate astigmatism within the WTR group, as compared to the ATR and oblique groups. Postoperative astigmatism reduction was found to be more predictable in the right eye than in the left eye.

Conclusion: The combination of FLAK can be considered as a potential method for reducing corneal astigmatism ranging from 1.00D to <3.00D. The highest reduction was observed in the WTR group, along with a higher rate of intended correction without astigmatism meridian shift in the right eye for the WTR group. However, factors such as cyclotorsion resulting from the surgical technique, alignment of docking, incision length, and preoperative astigmatism need to be taken into account for further enhancement and predictability of astigmatism reduction with this method.

Citing Articles

Surgical approaches to correct corneal astigmatism at time of cataract surgery: a mini-review.

Yin X, Ji Z, Li X, Liang X, Ji S Int J Ophthalmol. 2024; 17(7):1370-1374.

PMID: 39026920 PMC: 11246944. DOI: 10.18240/ijo.2024.07.23.

References

Nunez M, Henriquez M, Escaf L, Ventura B, Srur M, Newball L . Consensus on the management of astigmatism in cataract surgery. Clin Ophthalmol. 2019; 13:311-324. PMC: 6376888. DOI: 10.2147/OPTH.S178277. View

Visser N, Berendschot T, Verbakel F, de Brabander J, Nuijts R . Comparability and repeatability of corneal astigmatism measurements using different measurement technologies. J Cataract Refract Surg. 2012; 38(10):1764-70. DOI: 10.1016/j.jcrs.2012.05.036. View

Saunders H . Changes in the axis of astigmatism: a longitudinal study. Ophthalmic Physiol Opt. 1988; 8(1):37-42. View

Chen W, Zuo C, Chen C, Su J, Luo L, Congdon N . Prevalence of corneal astigmatism before cataract surgery in Chinese patients. J Cataract Refract Surg. 2012; 39(2):188-92. DOI: 10.1016/j.jcrs.2012.08.060. View

Nichamin L . Nomogram for limbal relaxing incisions. J Cataract Refract Surg. 2006; 32(9):1408. DOI: 10.1016/j.jcrs.2006.03.046. View

Roberts H, Wagh V, Sullivan D, Archer T, OBrart D . Refractive outcomes after limbal relaxing incisions or femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery. J Cataract Refract Surg. 2018; 44(8):955-963. DOI: 10.1016/j.jcrs.2018.05.027. View

Chan T, Wan K, Tang F, Wang Y, Yu M, Cheung C . Repeatability and Agreement of a Swept-Source Optical Coherence Tomography-Based Biometer IOLMaster 700 Versus a Scheimpflug Imaging-Based Biometer AL-Scan in Cataract Patients. Eye Contact Lens. 2019; 46(1):35-45. DOI: 10.1097/ICL.0000000000000603. View

Doganay F, Dadaci Z, Topcu-Yilmaz P, Doganay Aydin H . The association between ocular dominance and physiological palpebral fissure asymmetry. Laterality. 2016; 22(4):412-418. DOI: 10.1080/1357650X.2016.1209212. View

Asano K, Nomura H, Iwano M, Ando F, Niino N, Shimokata H . Relationship between astigmatism and aging in middle-aged and elderly Japanese. Jpn J Ophthalmol. 2005; 49(2):127-33. DOI: 10.1007/s10384-004-0152-1. View

10.

Namba H, Sugano A, Murakami T, Utsunomiya H, Nishitsuka K, Ishizawa K . Age-Related Changes in Astigmatism and Potential Causes. Cornea. 2020; 39 Suppl 1:S34-S38. DOI: 10.1097/ICO.0000000000002507. View

11.

Alio J, Abdou A, Arias Puente A, Zato M, Nagy Z . Femtosecond laser cataract surgery: updates on technologies and outcomes. J Refract Surg. 2014; 30(6):420-7. DOI: 10.3928/1081597X-20140516-01. View

12.

Spadea L, Giammaria D, Trabucco P . Corneal wound healing after laser vision correction. Br J Ophthalmol. 2015; 100(1):28-33. DOI: 10.1136/bjophthalmol-2015-306770. View

13.

Jester J, Villasenor R, Schanzlin D, Cavanagh H . Variations in corneal wound healing after radial keratotomy: possible insights into mechanisms of clinical complications and refractive effects. Cornea. 1992; 11(3):191-9. View

14.

Nagy Z, Takacs A, Filkorn T, Sarayba M . Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery. J Refract Surg. 2009; 25(12):1053-60. DOI: 10.3928/1081597X-20091117-04. View

15.

Collier Wakefield O, Annoh R, Nanavaty M . Relationship between age, corneal astigmatism, and ocular dimensions with reference to astigmatism in eyes undergoing routine cataract surgery. Eye (Lond). 2016; 30(4):562-9. PMC: 5108535. DOI: 10.1038/eye.2015.274. View

16.

Fouda S, Kamiya K, Aizawa D, Shimizu K . Limbal relaxing incision during cataract extraction versus photoastigmatic keratectomy after cataract extraction in controlling pre-existing corneal astigmatism. Graefes Arch Clin Exp Ophthalmol. 2010; 248(7):1029-35. DOI: 10.1007/s00417-009-1272-6. View

17.

Lim C, Somani S, Chiu H, Maini R, Tam E . Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram. Clin Ophthalmol. 2020; 14:1059-1070. PMC: 7183774. DOI: 10.2147/OPTH.S238016. View

18.

Visco D, Bedi R, Packer M . Femtosecond laser-assisted arcuate keratotomy at the time of cataract surgery for the management of preexisting astigmatism. J Cataract Refract Surg. 2019; 45(12):1762-1769. DOI: 10.1016/j.jcrs.2019.08.002. View

19.

Latz C, Asshauer T, Rathjen C, Mirshahi A . Femtosecond-Laser Assisted Surgery of the Eye: Overview and Impact of the Low-Energy Concept. Micromachines (Basel). 2021; 12(2). PMC: 7912418. DOI: 10.3390/mi12020122. View

20.

Azar D, Chang J, Han K . Wound healing after keratorefractive surgery: review of biological and optical considerations. Cornea. 2012; 31 Suppl 1:S9-19. PMC: 3682490. DOI: 10.1097/ICO.0b013e31826ab0a7. View