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Femtosecond-laser arcuate keratotomy for correcting astigmatism in pseudophakic patients

Session Details

Session Title: Femto-cataract

Session Date/Time: Monday 07/10/2013 | 08:00-10:00

Paper Time: 09:34

Venue: Forum (Ground Floor)

First Author: : C.Lindemann GERMANY

Co Author(s): :    P. Hoffmann              

Abstract Details

Purpose:

To evaluate predictability and safety of fs-Laser arcuate keratotomy at the time of cataract surgery and to develop a dose-response relationship.

Setting:

Private eye clinic in Germany

Methods:

50 eyes were evaluated in an ongoing prospective trial. All eyes had corneal astigmatism of 1.00 to 1.99 dpt and a vision-impairing cataract. For dosage, the vector mean of Lenstar keratometry and TMS5/Okulix tomography (including posterior corneal curvature) was chosen as this yielded the best results in toric IOL implantation. Using the Technolas Victus laser platform, capsulotomy, nucleus fragmentation and arcuate incisions were performed. The main incision was done manually as a post-limbal/scleral incision to minimize induced aberrations. The laser keratotomies were spread open with a conic hook. Postoperatively, the result was evaluated by manifest refraction, keratometry, topography and wavefront aberrometry.

Results:

Mean target astigmatism was 1.33 ± 0.38 dpt. Optical zone was 8.5mm in all cases, centred on the presumed line of sight. Mean length of the incisions was 42.8 ± 8.5°, mean depth 501 µm. Mean postop cylinder was 0.58 ± 0.50 (manifest refraction), 0.65 ± 0.30 (keratometry) and 0.72 ± 0.49 (topography). Mean induced cylinder change was 1.04 dpt equivalent to a correction index of 0.78. 83% of eyes had ? 0.75 dpt of refractive cylinder remaining. The amount of HOA is comparable to pseudophacic patients without AK (0.13 vs. 0.11 µm RMS). Details of the new nomogram will be presented.

Conclusions:

Femtosecond laser arcuate keratotomy is a safe, easy and predictable way of correcting low to moderate corneal astigmatism at the time of cataract surgery. It is much more predictable than manual LRI and may challenge the use toric IOL in eyes with < 2 dpt of corneal astigmatism. As with toric IOL, planning and calculating the correction of low power cylinders is not trivial.

Financial Interest:

NONE