Astigmatic keratotomy to correct preexisting astigmatism in cataract patients

Abstract

We evaluated three general strategies for dealing with astigmatism control following phacoemulsification with posterior chamber intraocular lens surgery: (1) a neutral wound closure to minimize surgically induced cylinder; (2) wound revision techniques to minimize residual postoperative cylinder; (3) astigmatic keratotomy incisions to treat preexisting astigmatism. With the neutral wound closure, mean postoperative keratometric cylinder averaged less than 1 diopter (D). In the presence of moderate preoperative astigmatism (1.0 D to 1.9 D), the wound revision technique tended to undercorrect, while the astigmatic keratotomy tended to overcorrect. However, the keratotomy procedure resulted in less postoperative cylinder. For cases with substantial preoperative astigmatism (greater than or equal to 2 D), the astigmatic keratotomy groups corrected more of the preoperative cylinder, which resulted in a greater proportion of cases with less than 1 D of postoperative cylinder and a smaller proportion with more than 2 D. Results suggest that astigmatic keratotomy is a useful adjunct to correct preexisting astigmatism in cataract patients. However, this procedure as any incisional refractive surgery technique has a certain amount of inherent biological variability.

Non-penetrating Femtosecond Laser Intrastromal Astigmatic Keratotomy in Patients With Mixed Astigmatism After Previous Refractive Surgery

“…2,[4][5][6][7][8][9][10] Due to the minimally invasive nature of this technique, it is commonly preferred for astigmatism treatment. [4][5][6][7][8][9][10] The major limitations with freehand or mechanical astigmatic incisions are technical diffi culties such as incision predictability and complications such as wound dehiscence. [8][9][10] Femtosecond laser technology has provided a new surgical modality in corneal surgery.…”

“…Astigmatic keratotomy is a well-established method for reducing refractive and keratometric cylinder. [4][5][6][7][8][9][10] The precision and accuracy of arcuate incisions in astigmatic keratotomy have signifi cantly improved due to the incorporation of femtosecond laser technology. 11 Promising results have been reported for treatment of high astigmatism that is naturally occurring 12 or due to keratoplasty [13][14][15][16][17][18][19] with femtosecond-assisted astigmatic keratotomy.…”

Long-term refractive stability following combined astigmatic keratotomy and phakoemulsification

“…For many years, cataract surgeons have used corneal relaxing incisions to reduce significant corneal astigmatism. A number of studies have demonstrated the effectiveness of modern techniques such as LRIs and astigmatic keratotomy [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

“…Correcting astigmatism at the time of cataract surgery is a logical goal, given that the aim of both procedures is to improve vision and frequently to reduce refractive error. Surgical procedures such as astigmatic keratotomy and LRIs can be combined with cataract surgery when cataract and corneal astigmatism coexist [14][15][16][17]. A newer approach to managing coincident cataract and astigmatism is implantation of a toric intraocular lens (IOL) during cataract surgery, which reduces total astigmatism [18][19][20][21][22][23][24][25][26].…”

Correção do astigmatismo na cirurgia da catarata

“…Desde o início da cirurgia refracional, as incisões corneanas eram utilizadas para a redução do astigmatismo pré-operatório durante a cirurgia de catarata (13)(14)(15)(16) . Tanto a utilização de incisões transversas, incisões arqueadas próximas ao centro da córnea, incisões corneanas perfurantes opostas à incisão principal e o aumento da incisão corneana foram utilizadas para a redução do astigmatismo pré-existente (13)(14)(17)(18) .…”