September 2018

RESIDENTS

EyeWorld journal club
Refractive outcomes after limbal relaxing incision or femtosecond laser-assisted astigmatic keratotomy in the management of corneal astigmatism at the time of cataract surgery


by Harry Roberts, MSc, Vijay Wagh, MD, Daniel Sullivan, MSc, Timothy Archer, MA(Oxon), David O’Brart, MD

J Cataract Refract Surg. 2018;44(8): 955–963.

Purpose: To compare the results of manual limbal relaxing incisions (LRI) performed during conventional phacoemulsification surgery (CPS) to non-penetrating femtosecond laser astigmatic keratotomies (FS-AK) performed during femtosecond laser-assisted cataract surgery (FLACS) in the management of corneal astigmatism.
Setting: Guy’s & St Thomas’ NHS Foundation Trust, London, U.K.
Design: Single center prospective randomized interventional case-controlled trial
Methods: This was a secondary outcome of a randomized controlled trial comparing the clinical outcomes and relative costs of 400 patients treated with CPS or FLACS. All trial patients with corneal astigmatism >0.9 D were offered treatment, either LRI or FS-AK based on the original randomization. FLACS was performed with a LenSx (Alcon, Fort Worth, Texas), and CPS was performed with an Infiniti phacoemulsification machine (Alcon). Visual acuity, postoperative refraction, and corneal topography were recorded as well as any surgical complications 4 weeks postoperatively. Vector analysis was performed using the Alpin’s method.
Results: 51 eyes of 51 patients received LRI and 53 eyes of 53 patients received FS-AK. The mean target induced astigmatism (TIA) was 1.5 D and 1.38 D, respectively, with 1.02 D and 1.23 D surgically induced astigmatism (SIA) (p=0.21), resulting in the FS-AK having a smaller difference vector (DV) 1.17 vs. 0.89 (p=0.02) and a greater correction index (CI) 0.48 vs. 0.73 (p=0.02). 44% of patients treated with FS-AK attained postoperative cylinder of <0.5 D compared with 20% in the LRI group (p=0.01). There were no complications in either group directly relating to the LRI/FS-AKs.
Conclusions: The FS-AK group achieved a higher CI and a smaller DV. FS-AK patients showed less postoperative cylinder than LRI patients.

Refractive outcomes after limbal relaxing incision or femtosecond laser-assisted astigmatic keratotomy in the management of corneal astigmatism at the time of cataract surgery Refractive outcomes after limbal relaxing incision or femtosecond laser-assisted astigmatic keratotomy in the
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2018-09-03T15:23:58Z
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