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Femtosecond laser arcuate keratotomy under flap for the correction of high astigmatism

Poster Details

First Author: A.Limão PORTUGAL

Co Author(s):    F. Laureano   P. Guerra           

Abstract Details


To determine the feasibility, efficacy and initial outcomes of femtosecond laser assisted arcuate keratotomies (AK) under a flap, to correct high astigmatism.


Rectrospective noncomparative interventional case series. Participants: Seven eyes of seven consecutive patients (mean age 45.86+/-14.94 years) who presented with a high degree of astigmatism(5 post-penetrating keratoplasty, 1 irregular postsurgical astigmatism and 1 post-traumatic astigmatism).


The Intralase (Intralase iFS, AMO, Santa Ana, California) femtosecond laser performed paired 90ẃ angled arcuate incisions under 110-120 microns flap . The incisions depths were performed from 100 microns under the surface to 80% of the corresponding minimal local corneal thickness, whereas the angular lengths varied between 45ẃ and 105ẃ and the optical zones between 5.8 and 6.0 mm, being determined by an adapted Lindstrom normogram. All flaps were lifted with opening of the arcuate incision with a Sinskey hook. Main Outcome Measures: Preoperative and postoperative manifest refraction, best spectacle-corrected visual acuity (BSCVA), subjective and topographic astigmatism.


Postoperative follow-up extended 1 month to 14 months; Best spectacle-corrected visual acuity improved from a mean of 0.41+/-0.21 preoperatively to 0.66+/-0.14 postoperatively (P=0.0314). The mean refractive cylinder decreased from 6.46+/-1.66D preoperatively to 3.11+/-2.41D postoperatively (P=0.0238). The mean topographic astigmatism decreased from 9.28+/-2.98D preoperatively to 4.27+/-1.94D (P=0.0070).


AK under a flap, performed with the femtosecond laser, was safe and effective in reducing high astigmatism with improvement of BSCVA. Performing arcuate incisions under a flap has important potential advantages, as avoidance of surface irregularity and the possibility of posterior enhancements with the excimer laser, re-lifting the flap.

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