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Deep intrastromal arcuate keratotomy with in situ keratomileusis (DIAKIK) for treatment of high naturally occurring astigmatism

Poster Details

First Author: P.Loriaut FRANCE

Co Author(s):    I. Goemaere   L. Jouve   V. Borderie   L. Laroche           

Abstract Details


To describe the first results of deep intrastromal arcuate keratotomy with in situ keratomileusis (DIAKIK) followed by excimer photoablation for management of high naturally occurring astigmatism.


The management of high naturally occurring astigmatism remains a major challenge when it is beyond the range of regular excimer laser surgery (PRK or LASIK).


Retrospective case series. The first step consisted of deep intrastromal arcuate keratotomy with lamellar keratotomy (corneal flap) at 100 µm depth by femtosecond laser. The corneal flap was manually lifted and the deep intrastromal incisions were rinsed with Balanced Salt Solution (BSS). One month later, a second step consisted of re-opening the flap and using an excimer laser to correct the residual ametropia with an in-situ keratomileusis.


Six eyes series were studied. Mean preoperative refractive cylinder correction was 4.42 ± 0.91 Diopters (D). The mean postoperative refractive cylinder correction was 1.20 ± 0.28 D. Mean correction index was 1.10 ± 0.13 D. The mean uncorrected distance visual acuity improved from 20/68 to 20/24 after the two steps. Mean follow-up was 4.5 months (range 3 to 9 months). No complications were observed and postoperative outcome was satisfactory.


Permitting correction of a broader range of high astigmatism with good accuracy, this combined approach minimizes excision of corneal stromal tissue and postoperative complications. Therefore, it allows correcting high ranges of ametropia, otherwise beyond the range of LASIK.

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