PurposeTo investigate the influence of keratometric astigmatism on visual outcomes following small incision lenticule extraction (SMILE).MethodsEighty eyes undergoing SMILE for myopia correction were classified into two groups based on preoperative keratometric astigmatism: low keratometric astigmatism (LA) and high keratometric astigmatism (HA) groups. Refractive outcomes, vector components, and changes in higher order aberrations (HOAs) were evaluated preoperatively and 6 months postoperatively.ResultsAt the postoperative 6-month visit, no significant difference was observed in the decentered distance between the HA and LA groups (HA: 0.17 ± 0.08 mm, LA: 0.16 ± 0.08 mm, P = 0.189). No significant differences in the correction index (P = 0.481), absolute angle of error (P = 0.104), or index of success (P = 0.147) were observed between the two groups. There was no significant difference in the induction of corneal aberrations between the two groups. Furthermore, there were no significant associations between the decentered distance and the vector components of astigmatic correction or induction of higher-order aberration in the HA group (P ≥ 0.294, P ≥ 0.112) or the LA group (P ≥ 0.323, P ≥ 0.080).ConclusionsSMILE for high keratometric astigmatism could achieve comparable treatment centration and visual quality to that of low keratometric astigmatism

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PURPOSE: To describe the preliminary corrective results of treating hyperopia and hyperopic astigmatism with toric lenticule implantation. METHODS: A 23-year-old man presented with corneal scars and aphakia in the right eye. Manifest refraction was +10.00 −1.25 × 165° and plano in the right and left eyes, respectively. Owing to the patient's rigid gas permeable contact lens intolerance and other factors, an allogenic toric lenticule from a donor eye with a refractive power of −8.50 −1.25 × 5° was implanted. The lenticule (refraction = +9.75 −1.25 × 95°) was transferred onto the exposed stromal bed of the recipient's eye and aligned to the marking axis (refraction = +9.75 −1.25 × 165°). The correction index was calculated using the online Alpins Statistical System for Ophthalmic Refractive Surgery Techniques vector calculator. RESULTS: At 6 months postoperatively, refraction of the right eye was +3.00 −0.25 × 160°. Anterior corneal surface curvature and astigmatism changed from 42.90 diopters, 2.30 @ 48.00 to 49.10 diopters, 1.50 @ 90.00. Optical coherence tomography showed smooth attachment of the lenticule to the stromal layer with visible boundaries. CONCLUSIONS: Toric lenticule implantation was beneficial in treating traumatic hyperopia and hyperopic astigmatism. Further studies are required to assess the effectiveness of this technique. [ Journal of Refractive Surgery Case Reports . 2022;2(1):e1–e5.]

Introduction: To compare the visual outcomes of astigmatism correction with implantable collamer lens (ICL) surgery with low-to-moderate astigmatism through a steep-meridian corneal relaxing incision (SM-CRI) and non-steepmeridian corneal relaxing incision (NSM-CRI). Methods: Seventy eyes of 70 patients with myopia and myopic astigmatism who underwent ICL V4c implantation were classified into two groups: SM-CRI and NSM-CRI. Refractive outcomes and vector analysis were evaluated preoperatively and 6 months postoperatively. Results: At the postoperative 6 month visit, all participants in both groups achieved an uncorrected distance visual acuity (UDVA) of 20/20 or better. The difference vector (DV) showed that the residual astigmatism in the SM-CRI group was much smaller than that in the NSM-CRI group (P = 0.021), and the correction index (CI) was 0.84 ± 0.30 and 0.67 ± 0.35 for the SM-CRI and NSM-CRI groups, respectively, with a significant statistical difference (P = 0.013). Approximately 71% of eyes in the SM-CRI group had an angle of error (AE) within ± 15°, whereas 55% of eyes in the NSM-CRI group were within that range. The absolute mean AE was 10.13 ± 14.57°in the SM-CRI group, compared with 23.88 ± 28.22°i n the NSM-CRI group (P = 0.038). Conclusion: SM-CRI can alleviate corneal astigmatism and decrease the cylindrical diopter of the ICL, thus improving postoperative visual quality compared with NSM-CRI.

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