Outcomes Of Femtosecond Laser Astigmatic Keratotomy Versus Toric Intraocular Lens Implantation In Treatment Of Astigmatic Patients Undergoing Femtosecond Cataract Surgery

Purpose: To evaluate the outcomes of Intrastromal Femtosecond laser-assisted Arcuate Keratotomy (ISAK) versus Toric Intra Ocular Lens (IOL) implantation in patients undergoing Femtosecond Laser-assisted Cataract Surgery in the treatment of eyes with low to moderate corneal astigmatism.

Egypt Air Hospital, Cairo, Egypt.

In this prospective interventional case series, 80 eyes with cataracts and low to moderate corneal astigmatism (1.0–3.0D) patients were randomly classified into two main groups.Group 1: Includes 40 eyes that were treated with Intrastromal femtosecond Laser astigmatic Keratotomy (ISAK) using Catalys Femto Laser Cataract System.Group 2:  Includes 40 eyes that were treated with femtosecond laser-assisted cataract surgery and Toric IOL implantation. All patients were subjected to medical history taking and comprehensive preoperative ophthalmological examination. Patients were evaluated postoperatively at 1 week, 1 and 3 months after surgery assessing subjective and objective refraction, and utilizing Pentacam and idesign aberrometery.

 Results showed that the refractive astigmatism was significantly reduced in both the toric IOL group and ISAK group (P<0.001) while corneal astigmatism was significantly reduced in the ISAK group (P <0.05). There was a marked improvement in both uncorrected and best-corrected distance visual acuity in both groups. The mean postoperative astigmatism in the toric IOL group was 0.50 ± 0.13 while in the ISAK group was 0.75 ± 0.50. At 3 months postoperatively, the toric IOL group demonstrated stable results especially in cases with astigmatism ≥ 1.50 D, while the ISAK group demonstrated a slight correction under-correction at the 3 month follow-up and decreased efficacy in moderate grade astigmatism. 

Both toric IOL and ISAK are effective in the correction of low to moderate-grade astigmatism. However, in our study toric IOL showed superior and more stable results in correction of astigmatism especially, if the magnitude of astigmatism was ≥1.50 diopter. Meanwhile, the ISAK group demonstrated slight under-correction and decreased efficacy at 3 months follow up as well as a higher incidence of high order aberrations.