Femtosecond laser assisted phacoemulsification plus IOL implant: toric IOL vs. astigmatic keratotomy.

PURPOSE: To compare the clinical outcomes of femtosecond laser-assisted cataract surgery (FSLACS) with astigmatic keratotomy (AK) versus toric intraocular lens (IOLt) implantation for astigmatism correction.

DESIGN

Retrospective comparative case series.

METHODS

60 eyes (45 IOLt cases and 15 AK cases) with patient's mean age of 61.46 ± 12.84 years underwent FSLACS with astigmatic correction. Pre and post-operative evaluations included autorefractometry, corneal topography, IOL Master analysis, and assessment of total ocular astigmatism (OAtot), anterior/posterior/total corneal astigmatism (CAant/CApost/CAtot), corneal higher-order aberrations (HOAs), vector analysis, and best-corrected/uncorrected distant visual acuity (BCVA; UDVA; LogMAR). The average follow-up period was 16.29 ± 11.15 months.

RESULTS

In term of OAtot as demonstrated by polar plots, significant reductions were observed in both the IOLt and the AK groups (p < 0.001). In regard to CAant, a statistically significant change was observed in the AK group. No significant change was noted in the IOLt group. In view of CApost, there was no statistically significant difference in CApost for either the IOLt or AK groups, indicating stability of the posterior corneal surface. As for CAtot, the AK group showed a significant pre to post-operative change (p < 0.001). No significance was found in the IOLt group. Likewise, corneal HOAs remained stable in IOLt but significantly increased in AK (p < 0.01). This is associated with a significant intergroup difference of p < 0.001. Vector astigmatism analysis utilizing Double Angle Vector Diagrams to show that TIA/SIA/DV/CI for the IOLt group and for the AK group. Vector astigmatism analysis implied that there was no significant difference in target/surgery induced astigmatism (TIA/SIA) between groups. BCVA (LogMAR) improved significantly in both groups [IOLt: 0.40 (0.40, 0.50) to 0.10 (0.00, 0.10); AK: 0.40 (0.40, 0.50) to 0.10 (0.10, 0.15); both p < 0.001]. There is with no significant difference between both groups (p = 0.49).

CONCLUSION

FSLACS with toric IOL implantation offers an effective and more stable astigmatism correction without increasing HOAs, but also having similar visual outcome improvement, when compared to AK's astigmatism correction.