Combined Femtosecond Laser-Assisted Keratotomy and Cataract Surgery for Enhancing Refractive Outcomes. An Indonesian Case Study

Abstract

Purpose

We evaluate the reduction of corneal astigmatism and the improvement of visual outcomes of this surgical method in the Indonesian population. We also assess the accuracy and predictability of using femtosecond laser astigmatic keratotomy (FLAK) combined with cataract surgery.

Patients and Methods

In a retrospective study, a total of 275 subjects (78 with against-the-rule (ATR) astigmatism, 178 with with-the-rule (WTR) astigmatism, and 19 with oblique (OBL) astigmatism) with preexisting corneal astigmatism ranging from 0.75D to 3.00D underwent FLAK. All subjects completed a 3-month follow-up. The femtosecond laser used for creating paired AK 2.2 mm, primary incision, and paracentesis incision was the FEMTO Z8 NEO from Ziemer Ophthalmic System, Switzerland. The surgical approach was guided by the “NAPA” nomogram.

Results

The reduction in postoperative astigmatism was 56.90% for the WTR group, 49.46% for the ATR group, and 47.33% for the oblique group. A significant reduction in astigmatism was observed at the 1-week, 1-month, and 3-month follow-up intervals in both the WTR and ATR groups. The reduction in astigmatism was more favorable in cases of moderate astigmatism within the WTR group, as compared to the ATR and oblique groups. Postoperative astigmatism reduction was found to be more predictable in the right eye than in the left eye.

Conclusion

The combination of FLAK can be considered as a potential method for reducing corneal astigmatism ranging from 1.00D to <3.00D. The highest reduction was observed in the WTR group, along with a higher rate of intended correction without astigmatism meridian shift in the right eye for the WTR group. However, factors such as cyclotorsion resulting from the surgical technique, alignment of docking, incision length, and preoperative astigmatism need to be taken into account for further enhancement and predictability of astigmatism reduction with this method.

Keywords:

• femtosecond laser-assisted cataract surgery
• FLACS
• astigmatic keratotomy
• AK
• femtosecond laser astigmatic keratotomy
• FLAK
• corneal astigmatism correction

Abbreviations

FLACS, femtosecond laser-assisted cataract surgery; ATR, against-the-rule; WTR, with-the-rule; OBL, oblique; D, dioptre; AK, astigmatic keratotomy; WHO, World Health Organization; OCCI, opposite clear corneal incisions; LRI, limbal relaxing incisions; IOL, intraocular lens; CCW, counter clockwise; CW, clockwise; NA, Not applicable.

Disclosure

The authors report no conflicts of interest in this work.