Outcome of astigmatism correction using femtosecond laser combined with cataract surgery: penetrating vs intrastromal incisions

Wang, Li; Scott, Wendell J.; de, Ildamaris Montes; Koch, Douglas D.; Tauber, Shachar; Al-Mohtaseb, Zaina

doi:10.1097/j.jcrs.0000000000000911

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…4 In femtosecond laser-assisted cataract surgery combined with penetrating and intrastromal corneal relaxing incisions, multiple regression analyses revealed that longer corneal relaxing incision length, higher preoperative corneal astigmatism magnitude, and ATR corneal astigmatism produced greater net corneal changes. 14 In this study, no correlation between the net refractive changes and incision length was found when a single PCRI was made, whereas refractive changes and incision length were correlated with paired incisions, but with a small correlation coefficient. This discrepancy may be explained by 2 factors: (1) In this study, PCRIs were used to reduce the residual manifest refractive astigmatism; in contrast, previous studies noted above used PCRIs to reduce corneal astigmatism; and (2) in this study, sample size and range of incision length were small (32 to 45 degrees) in the single PCRI group.…”

Section: Discussioncontrasting

confidence: 57%

Outcomes of peripheral corneal relaxing incisions for residual astigmatism in patients after cataract surgery

Wang

Koch

2023

J Cataract Refract Surg

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Purpose: To evaluate the outcomes of peripheral corneal relaxing incisions (PCRIs) for correcting residual astigmatism in eyes after cataract surgery. Setting: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. Design: Retrospective case series. Methods: Retrospectively, we reviewed all consecutive cases that had previous cataract surgery and subsequent PCRIs by 1 surgeon. The PCRI length was determined according to a nomogram based on age and manifest refractive astigmatism. Visual acuity and manifest refractive astigmatism before and after the PCRIs were compared. Vector analysis was performed, and net refractive changes along the incision meridian were calculated. Results: Criteria were met by 111 eyes. After the PCRIs, mean uncorrected visual acuity was significantly improved, and the percentage of eyes with uncorrected distance visual acuity of ≥20/20 increased significantly by 36%; the mean refractive astigmatism magnitude decreased significantly, and the percentages of eyes with refractive cylinder of ≤0.25 diopters (D) and ≤0.50 D increased significantly by 63% and 75%, respectively (all P < .05). The vector magnitude difference between pre- and post-operative refractive astigmatism was 0.88 ± 0.38 D. The postoperative refractive astigmatism had significantly smaller centroid and variance values than the preoperative refractive astigmatism (P < .05). Conclusions: PCRIs are an effective approach for correcting low amounts of residual astigmatism in patients after cataract surgery.

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Section: Discussioncontrasting

confidence: 57%

Outcomes of peripheral corneal relaxing incisions for residual astigmatism in patients after cataract surgery

Wang

Koch

2023

J Cataract Refract Surg

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“…Similar to our study, AK with FLACS, anterior penetrating and intrastromal, found greater astigmatic changes in patients with preoperative ATR astigmatism. 30 The major limitations of our study are that it is retrospective, and a well-established nomogram to calculate manual LRIs using ACA data was arbitrarily modified to calculate the parameters for femtosecond AKs. Our modification is similar to a published nomogram comparing LRI versus femtosecond AK, side by side.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to our study, AK with FLACS, anterior penetrating and intrastromal, found greater astigmatic changes in patients with preoperative ATR astigmatism. 30…”

Section: Discussionmentioning

confidence: 99%

Using Total Corneal Astigmatism With Femtosecond Laser Cataract Surgery and Arcuate Keratotomy(ies) to Treat Low Amounts of Astigmatism

Cohen,

Patel

2024

Cornea

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Purpose: The aim of this study was to evaluate outcomes using total corneal astigmatism (TCA) to calculate arcuate keratotomy(ies) (AK) parameters performed with femtosecond laser-assisted cataract surgery to reduce low corneal astigmatism. Methods: Patients who had femtosecond laser-assisted cataract surgery and AK with 0.50 diopter (D) to 1.30 D of TCA were included. Exclusion criteria were intraoperative complications, preexisting corneal surgery, and comorbidities that might adversely affect outcomes. Corneal tomography (Galilei G4, Zeimer Ophthalmic Systems AG) was performed preoperatively and 1 month postoperatively. TCA was input into the Donnenfeld limbal relaxing incisions nomogram to calculate the AK parameters. Preoperative and postoperative tomographic and subjective refractive measurements were compared. The Alpins method for vector analysis evaluated results. Results: Eighty-two eyes of 82 patients were included. Mean preoperative TCA was significantly reduced from 0.80 ± 0.19 D to 0.51 D ± 0.26 D (P < 0.001). Preoperative posterior corneal astigmatism, −0.28 ± 0.13 D, was unchanged, postoperative posterior corneal astigmatism, −0.28 ± 0.14 D (P = 0.653). Target-induced astigmatism arithmetic mean (0.82 ± 0.21 D) was greater than that of the surgically induced astigmatism (0.70 ± 0.40 D), resulting in an arithmetic mean difference vector of 0.51 ± 0.27 D with a summated mean at 0.16 D at 20 degrees. The correction index was 0.87, indicating undercorrection. Angle of error arithmetic mean, −1.27 ± 23.27 degrees, indicated good alignment. Conclusions: Inputting TCA for calculation of femtosecond laser AK parameters can reduce low amounts of preoperative corneal astigmatism, thereby improving uncorrected vision.

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“…On the other hand, Ganesh et al[ 81 ] in a randomized clinical trial, demonstrated that although anterior penetrating and iAK incisions were effective in reducing preoperative astigmatism using the FLS, the transepithelial approach showed comparatively better correction. Recently, Wang et al [ 76 ] in another large-sample randomized clinical trial demonstrated comparable outcomes.…”

Section: Astigmatism Correction With Corneal Incisionsmentioning

confidence: 99%

Managing low corneal astigmatism in patients with presbyopia correcting intraocular lenses: a narrative review

Rocha‐de‐Lossada

Rodríguez‐Vallejo

Rodríguez‐Calvo‐de‐Mora

et al. 2023

BMC Ophthalmol

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Cataract surgery has become a refractive procedure in which emmetropia is the goal, with the implantation of extended depth-of-focus or multifocal intraocular lenses (IOLs) being the commonly selected option to restore vision beyond the far distance. The selection criteria for implanting these lenses can differ from those for monofocal IOLs and even between technologies, as eye characteristics can affect postoperative visual performance. Corneal astigmatism is an eye characteristic that can affect visual performance differently, depending on the implanted IOL. The magnitude of corneal astigmatism, the tolerance of the IOL to this astigmatism, economic aspects, comorbidities, and the efficacy of astigmatism treatment are factors that can make surgeons’ doubt as to what astigmatism treatment should be applied to each patient. This review aims to summarize the current evidence related to low astigmatism tolerance in presbyopia-correcting lenses, the efficacy achieved through corneal incisions, and their comparison with the implantation of toric IOLs.

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Outcome of astigmatism correction using femtosecond laser combined with cataract surgery: penetrating vs intrastromal incisions

Abstract: To compare the effectiveness of penetrating vs intrastromal femtosecond laser corneal relaxing incisions (CRIs) in reducing corneal astigmatism during cataract surgery.

Cited by 8 publications

References 26 publications

Outcomes of peripheral corneal relaxing incisions for residual astigmatism in patients after cataract surgery

Outcomes of peripheral corneal relaxing incisions for residual astigmatism in patients after cataract surgery

Using Total Corneal Astigmatism With Femtosecond Laser Cataract Surgery and Arcuate Keratotomy(ies) to Treat Low Amounts of Astigmatism

Managing low corneal astigmatism in patients with presbyopia correcting intraocular lenses: a narrative review

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