Abstract
Objective To evaluate corneal astigmatic outcomes of femtosecond laser-assisted arcuate keratotomies (FAKs) combined with femtosecond laser-assisted cataract surgery (FLACS) over 12-month follow-up.
Methods One hundred forty-five patients with bilateral cataracts and no ocular co-morbidities were recruited to a single-centre, single-masked, prospective randomised controlled trial (RCT) comparing two monofocal hydrophobic acrylic intraocular lenses. Eyes with corneal astigmatism (CA) of >0.8 dioptres (D) received unpaired, unopened, surface penetrating FAKs at the time of FLACS. Visual acuity, subjective refraction and Scheimpflug tomography were recorded at 1, 6, and 12 months. Alpins vectoral analyses were performed.
Results Fifty-one patients (61 eyes), mean age 68.2±9.6 years [standard deviation (SD)], received FAKs. Sixty eyes were available for analysis, except at 12 months when 59 attended. There were no complications due to FAKs. Mean pre-operative CA was 1.13±0.20 D. There was a reduction of astigmatism at all post-operative visits (residual CA 1 month: 0.85±0.42 D, p<0.001; 6 months: 0.86±0.35 D, p<0.001; and 12 months: 0.90±0.39, p<0.001). Alpins indices remained stable over 12 months. Overall, the cohort was under-corrected at all time points. At 12 months, 61% of eyes were within ±15 degrees of pre-operative astigmatic meridian.
Conclusion Unpaired unopened penetrating FAKs combined with on-axis phacoemulsification are safe but minimally effective. CA is largely under-corrected in this cohort using an existing unmodified nomogram. The effect of arcuate keratotomies on CA remained stable over 12 months.
