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Cohen KL, Patel NK. Using Total Corneal Astigmatism With Femtosecond Laser Cataract Surgery and Arcuate Keratotomy(ies) to Treat Low Amounts of Astigmatism. Cornea 2024; 43:999-1007. [PMID: 38289747 DOI: 10.1097/ico.0000000000003482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024]
Abstract
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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Affiliation(s)
- Kenneth L Cohen
- School of Medicine, Department of Ophthalmology and the Kittner Eye Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Sandhu U, Osborn AR, Dang DH, Murphy DA, Langenbucher A, Wendelstein JA, Riaz KM. Refractive Astigmatism Outcomes of Femtosecond Laser-Assisted Arcuate Keratotomies Combined with Femtosecond Laser-Assisted Cataract Surgery: Two-Year Results. Curr Eye Res 2024:1-11. [PMID: 38780904 DOI: 10.1080/02713683.2024.2353268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To evaluate the effectiveness and stability of refractive astigmatism reduction after penetrating femtosecond laser-assisted arcuate keratotomy performed at the time of femtosecond laser-assisted cataract surgery. METHODS Non-randomized retrospective data analysis of all patients that underwent femtosecond laser-assisted cataract surgery with femtosecond laser-assisted arcuate keratotomy over a 4-year period with a non-toric monofocal intraocular lens (2017-2021) at a tertiary care academic center. Postoperative visual acuity, manifest refraction, and predicted residual refractive error were also recorded at 1 month, 3-6 months, 12-18 months, and 2 years postoperatively. Preoperative keratometric astigmatism was compared to postoperative refractive astigmatism using vector calculations and the ASCRS double-angle plot tool. RESULTS This study comprised 266 eyes (179 patients) that met inclusion criteria. The mean preoperative keratometric astigmatism magnitude was 0.99 ± 0.53 D. At 1 month, 3-6 months, 12-18 months, and 2 years postoperatively, the mean refractive cylinder was 0.49 ± 0.45 D, 0.49 ± 0.45 D, 0.55 ± 0.54 D, and 0.52 ± 0.46 D, respectively. Horizontal against-the-rule astigmatism showed a higher tendency toward undercorrection than vertical with-the-rule astigmatism, which had a slightly higher tendency toward overcorrection. With-the-rule astigmatism had smaller difference vectors between target-induced astigmatism and surgically induced astigmatism. CONCLUSIONS Femtosecond laser-assisted arcuate keratotomy performed at the time of femtosecond laser-assisted cataract surgery was an effective option for correcting low-to-moderate corneal astigmatism for up to 2 years.
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Affiliation(s)
- Umar Sandhu
- College of Medicine, University of Oklahoma, Oklahoma City, OK, USA
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - Andrew R Osborn
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
- Missouri Eye Institute, Springfield, MO, USA
| | - Deanna H Dang
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - David A Murphy
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Jascha A Wendelstein
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
- Department for Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria
- Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland
| | - Kamran M Riaz
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
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Yen WT, Weng TH, Lin TY, Tai MC, Chen YH, Chang YM. Femtosecond laser-assisted astigmatic keratotomy versus toric IOL implantation for correcting astigmatism in cataract patients: a systematic review and meta-analysis with trial sequential analysis. Br J Ophthalmol 2024:bjo-2024-325195. [PMID: 38575199 DOI: 10.1136/bjo-2024-325195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024]
Abstract
AIMS To compare the refractive and visual outcomes of femtosecond laser-assisted astigmatic keratotomy (FSAK) and toric intraocular lens (IOL) implantation for correcting astigmatism in cataract patients. METHODS Studies were retrieved from the Ovid-Medline, EMBASE, Cochrane Central Register of Controlled Trials and Scopus which compared FSAK and toric IOL for astigmatism correction in cataract patients. Outcome measures included postoperative refractive cylinder, correction index, uncorrected distance visual acuity (UDVA), the proportion of patients achieving a residual refractive cylinder of 1.00 dioptre or less, target-induced astigmatism (TIA) and surgically induced astigmatism (SIA). The trial sequential analysis (TSA) was used to collect firm evidence supporting our conclusion. RESULTS 9 studies encompassing 590 participants were analysed. The meta-analysis revealed that toric IOLs could result in less postoperative refractive cylinder and provide better UDVA compared with FSAK. The TSA disclosed strong evidence of lower postoperative refractive cylinder in the toric IOL group compared with that of the FSAK group. FSAK showed a smaller correction index and lower mean TIA and SIA compared with toric IOLs. CONCLUSIONS For cataract patients, both FSAK and toric IOLs are effective methods for correcting astigmatism. However, toric IOLs offer less postoperative astigmatism and result in better postoperative UDVA compared with FSAK. In vector analysis of astigmatism, toric IOLs can also produce higher TIA and SIA. Additionally, neither method is associated with severe untreatable complications. Therefore, the conclusion is that toric IOLs are the preferred choice for astigmatism correction in cataract patients and FSAK serves as a viable alternative when toric IOLs are contraindicated.
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Affiliation(s)
- Wei-Ting Yen
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Ting-Yi Lin
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Yu-Min Chang
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
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Salgado RMPC, Torres PFAAS, Marinho AAP. Update on Femtosecond Laser-Assisted Cataract Surgery: A Review. Clin Ophthalmol 2024; 18:459-472. [PMID: 38375440 PMCID: PMC10875176 DOI: 10.2147/opth.s453040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024] Open
Abstract
The advent of femtosecond lasers has resulted in a new standard in cataract surgery, intended to overmatch the paradigm of conventional phacoemulsification. Femtosecond laser-assisted cataract surgery (FLACS) enables a higher level of reproducibility, precision, accuracy, and customization when performing several steps of cataract (or lens) surgery. Capsulotomy, corneal incisions, lens fragmentation, and arcuate incisions are the main procedures performed using FLACS. As the demand for better refractive outcomes and spectacle independence increases, the features of FLACS are highly relevant, especially when considering the implantation of premium intraocular lenses, such as toric, enhanced depth-of-focus, or multifocal lenses. The present article reviews the state of the art of femtosecond laser-assisted cataract (lens) surgery, contemplating the advantages and limitations of the two types of femtosecond laser pulses available (high and low energy) by evaluating their reported outcomes and complications.
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Affiliation(s)
- Ramiro M P C Salgado
- Departamento de Oftalmologia do Hospital da Arrábida, Hospital de Santo António, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Paulo F A A S Torres
- Departamento de Oftalmologia do Hospital da Prelada, Universidade do Porto, Porto, Portugal
| | - Antonio A P Marinho
- Departamento de Oftalmologia do Hospital da Luz Arrábida, Universidade do Porto, Porto, Portugal
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Narang R, Agarwal A. Refractive cataract surgery. Curr Opin Ophthalmol 2024; 35:23-27. [PMID: 37962881 DOI: 10.1097/icu.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW The aim of this study to provide an overview of recent publications and opinions in refractive cataract surgery. RECENT FINDINGS With the advent of intraocular lenses (IOLs) on different platforms, the surgeon has a wide arena of types of IOL to choose, depending on the patient's visual requirement. Optimization of the tear film, integrating tomography and topography devices for appropriate keratometry values, biometry, use of advanced formulas for IOL power calculation and application of newer IOLs can help achieve target refraction in cases scheduled for cataract surgery. Intraoperative aberrometry can be a useful aid for cataract surgery in postrefractive cases and can help minimize residual postoperative astigmatism. SUMMARY Evolvement and rapid advancement of technology allows to impart desired refractive outcomes in most of the cases postcataract surgery. Appropriate preoperative and intraoperative factors should be considered to achieve the desired postoperative outcome.
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Affiliation(s)
- Rhea Narang
- SMT. NHL Medical College, Ahmedabad, Gujarat
| | - Ashvin Agarwal
- Dr Agarwal's Eye Hospital & Research Centre, Chennai, Tamil Nadu, India
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Zheng J, He L, Zhong J. Effect of femtosecond laser-assisted arcuate keratotomy versus toric intraocular lens implantation on correction of astigmatism in cataract surgery: a systematic review and meta-analysis. Lasers Med Sci 2023; 38:225. [PMID: 37773468 DOI: 10.1007/s10103-023-03893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To compare the efficacy of femtosecond laser-assisted arcuate keratotomy (FSAK) combined with non-toric intraocular lens (IOL) implantation versus Toric IOL (TIOL) implantation in correcting corneal astigmatism in cataract patients. METHODS Relevant literature was searched in databases including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and SinoMed. Data from the included studies were extracted. A meta-analysis was conducted to compare the correction performance of FSAK combined with non-toric IOL implantation and TIOL implantation using postoperative refractive astigmatism, correction index, and uncorrected distance visual acuity (UDVA) outcomes. Publication bias assessment and sensitivity analysis were also performed. RESULTS Five comparative studies were ultimately included in the meta-analysis. The TIOL group had smaller postoperative refractive astigmatism and a greater correction index compared to the FSAK group. The mean differences in postoperative refractive astigmatism and correction index between the two groups were - 0.19D (95% CI = 0.12 to 0.26, P < 0.01, I2 = 7%) and - 0.09 (95% CI = - 0.18 to 0.00, P = 0.04, I2 = 0%), respectively. We found no statistically significant difference in UDVA between the two groups (95% CI = - 0.01 to 0.11, P = 0.09, I2 = 70%). CONCLUSIONS FSAK combined with non-toric IOL implantation was found to be less effective than TIOL implantation in correcting preoperative corneal astigmatism in cataract patients. The difference in the effectiveness of astigmatism correction between the two surgical methods seems to diminish, as the degree of preoperative corneal astigmatism decreases.
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Affiliation(s)
- Jiang Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Lun He
- Department of Ophthalmology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510260, China
| | - Jingxiang Zhong
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.
- The Sixth Affiliated Hospital of Jinan University, Jinan University, Dongguan, 523129, China.
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Liu S, Liu J, Lin F, Yu L, Cheng C, Wang T, Zhou X. Efficacy Comparison Between Steep-Meridian Incision and Non-Steep-Meridian Incision in Implantable Collamer Lens Surgery with Low-to-Moderate Astigmatism. Ophthalmol Ther 2023; 12:1711-1722. [PMID: 37016057 PMCID: PMC10164207 DOI: 10.1007/s40123-023-00704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/16/2023] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION To compare the visual outcomes of astigmatism correction with implantable collamer lens (ICL) surgery with low-to-moderate astigmatism through a steep-meridian corneal relaxing incision (SM-CRI) and non-steep-meridian corneal relaxing incision (NSM-CRI). METHODS Seventy eyes of 70 patients with myopia and myopic astigmatism who underwent ICL V4c implantation were classified into two groups: SM-CRI and NSM-CRI. Refractive outcomes and vector analysis were evaluated preoperatively and 6 months postoperatively. RESULTS At the postoperative 6 month visit, all participants in both groups achieved an uncorrected distance visual acuity (UDVA) of 20/20 or better. The difference vector (DV) showed that the residual astigmatism in the SM-CRI group was much smaller than that in the NSM-CRI group (P = 0.021), and the correction index (CI) was 0.84 ± 0.30 and 0.67 ± 0.35 for the SM-CRI and NSM-CRI groups, respectively, with a significant statistical difference (P = 0.013). Approximately 71% of eyes in the SM-CRI group had an angle of error (AE) within ± 15°, whereas 55% of eyes in the NSM-CRI group were within that range. The absolute mean AE was 10.13 ± 14.57° in the SM-CRI group, compared with 23.88 ± 28.22° in the NSM-CRI group (P = 0.038). CONCLUSION SM-CRI can alleviate corneal astigmatism and decrease the cylindrical diopter of the ICL, thus improving postoperative visual quality compared with NSM-CRI.
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Affiliation(s)
- Shengtao Liu
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China
| | - Jingying Liu
- Jiangxi Research Institute of Ophthalmology and Visual Sciences, Department of Affiliated Eye Hospital, Nanchang University, Nanchang, China
| | - Feng Lin
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China
| | - Lanhui Yu
- Jiangxi Research Institute of Ophthalmology and Visual Sciences, Department of Affiliated Eye Hospital, Nanchang University, Nanchang, China
| | - Chiwen Cheng
- Jiangxi Research Institute of Ophthalmology and Visual Sciences, Department of Affiliated Eye Hospital, Nanchang University, Nanchang, China
| | - Ti Wang
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China.
| | - Xingtao Zhou
- Key Lab of Myopia, Ministry of Health, Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China.
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Kecik M, Schweitzer C. Femtosecond laser-assisted cataract surgery: Update and perspectives. Front Med (Lausanne) 2023; 10:1131314. [PMID: 36936227 PMCID: PMC10017866 DOI: 10.3389/fmed.2023.1131314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/07/2023] [Indexed: 03/06/2023] Open
Abstract
Cataract surgery is among the most frequently performed surgical procedures worldwide and has a tremendous impact on patients' quality of life. Phacoemulsification (PCS) is accepted as a standard of care; its technique has continuously evolved and already achieved good anatomical, visual, and refractive outcomes. Lasers in ophthalmology are widely used in clinical practice, femtosecond lasers (FSLs) for corneal surgery in particular. It was natural to assess the usefulness of FSL in cataract surgery as this technology was within reach. Indeed, precise and reproducible cuttings provided by FSL platforms could improve standardization of care and limit the risk associated with the human element in surgery and provide a step toward robot-assisted surgery. After docking and planning the procedure, femtosecond lasers are used to perform corneal incisions, capsulorhexis, lens fragmentation, and arcuate incisions in an automated manner. A well-constructed corneal incision is primordial as it offers safety during the procedure, self-seals afterward, and influences the refractive outcome. Capsulorhexis size, centration, and resistance to shearing influence the surgery, intraocular lens (IOL) centration and stability, and posterior capsular opacification formation. Lens fragmentation is where most of the energy is delivered into the eye, and its amount influences endothelial cell damage and potential damage to other ocular structures. The arcuate incisions offer an additional opportunity to influence postoperative astigmatism. Femtosecond laser-assisted cataract surgery (FLACS) has been a topic of research in many studies and clinical trials that attempted to assess its potential benefits and cost-effectiveness over PCS and is the subject of this mini-review.
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Affiliation(s)
- Mateusz Kecik
- Department of Ophthalmology, Hopitaux Universitaires de Genève (HUG), Genève, Switzerland
| | - Cedric Schweitzer
- Department of Ophthalmology, CHU Bordeaux, Bordeaux, France
- INSERM, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, Univ. Bordeaux, Bordeaux, France
- *Correspondence: Cedric Schweitzer
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