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Giovanni Greaves, Benny Wong, Aysha Malik, Sajid Malik, Thierry Hufnagel, Lisa Rosen, Carolyn Shih; Astigmatic Outcomes for Arcuate Incisions in Femtosecond Laser Assisted Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5778. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The use of femtosecond laser cataract surgery (FLCS) has dramatically increased. As such, using the femtosecond laser to perform arcuate incisions for corneal cylinder (CC) correction is becoming more common. Our study seeks to compare the efficacy of intrastromal versus anterior penetrating arcuate incisions on reducing pre-operative CC in FLCS.
A retrospective chart review was performed of patients undergoing FLCS over one year by three different surgeons. Age, gender, pre-operative corneal cylinder, type of LRI incision, ocular and medical history were all collected. Preoperative parameters including anterior chamber depth, central corneal thickness, length of incision, and IOL used were also collected. Postoperative corneal cylinder and complications were collected and reviewed. Eyes with a toric IOL were excluded. Pre- and post-operative keratometry were measured with Zeiss IOLMaster 500 and NIDEK AR-1 autorefractor at 1, 2/3 and at 6 months. Linear mixed models for repeated measures were used to examine cylinder over time (from pre-operative to post-operative) and compare between incision types.
There were a total of 198 eyes of 162 subjects included in our study. There were 86 (43.43%) anterior penetrating and 112 (56.57%) intrastromal eyes. In the anterior penetrating group, preoperatively CC was 0.75 D (95% CI 0.65, 0.86) and at postoperative month 1, CC had decreased to 0.60 D (95% CI 0.51, 0.70) and at months 2/3 (95% CI 0.38, 0.58), CC had dropped to 0.46 D and at month 6 was 0.57 D (95% CI 0.38, 0.79). In the intrastromal group, preoperatively CC was 0.84 D (95% CI 0.75, 0.94) and at postoperative month 1, CC was 0.76 D, (95% CI 0.67, 0.86) and had decreased to 0.74 D (95% CI 0.56, 0.94) at months 2/3 with a further decline to 0.49 D (95% CI 0.19, 0.93) at month 6 postoperatively. Patients undergoing intrastromal incisions had no significant complications. One patient from the anterior penetrating group had a small wound leak from the arcuate incision which self-resolved over time without suturing.
Our experience with anterior penetrating and intrastromal corneal incisions for patients undergoing femtosecond laser cataract surgery demonstrate that both incisions are associated with a decrease in corneal cylinder over time.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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