Two-Year Outcomes After Full-Thickness Astigmatic Keratotomy Combined with Small-Incision Lenticule Extraction for High Astigmatism

Abstract

Purpose: To evaluate clinical outcomes after full-thickness astigmatic keratotomy (FTAK) combined with small-incision lenticule extraction (SMILE) in eyes with high astigmatism.Methods: This study comprised 75 eyes of 43 patients with over 4.0 diopters (D) of astigmatism who were treated with SMILE after FTAK. Visual acuities and refractive measurements were evaluated at 1 month after FTAK, and 1, 6, 12, and 24 months after SMILE. Vector analysis of the astigmatic changes was performed using the Alpins method.Results: Twenty-four months after the combined procedure, the average spherical equivalent was reduced from -6.56 ± 2.38 D to -0.36 ± 0.42 D (p < 0.001). The uncorrected and corrected distance visual acuities improved from 1.54 ± 5.53 to -0.02 ± 0.09 and from -0.03 ± 0.07 D to -0.07 ± 0.08 D (both p < 0.001), respectively. The preoperative mean astigmatism was -5.48 ± 1.17 D, which was reduced to -2.27 ± 0.97 D and -0.34 ± 0.26 D at 1 month after FTAK and 24 months after SMILE, respectively (p <0.001). The surgically-induced astigmatism after FTAK, SMILE, and FTAK and SMILE combined was 3.38 ± 1.18 D, 2.22 ± 0.84 D, and 5.39 ± 1.20 D, respectively. Furthermore, the correction index of FTAK, SMILE, and FTAK and SMILE combined was 0.63 ± 0.17, 0.90 ± 0.40, and 0.98 ± 0.06, respectively. There were no intraoperative or postoperative complications. Conclusion: Our surgical procedure combining FTAK and SMILE showed good and stable clinical outcomes during two-year follow-up for the treatment of high astigmatism.