Efficacy And Safety Of Femtosecond Laser-Assisted Arcuate Keratotomy Combined With Cataract Surgery For Moderate Astigmatism Correction

To evaluate the efficacy and safety of arcuate keratotomies (AK) performed with the Victus femtosecond laser platform in combination with cataract surgery for the treatment of moderate astigmatism.

This prospective, multicenter study was conducted in specialized ophthalmology centers. All arcuate keratotomies were performed using the Victus femtosecond laser in combination with standard phacoemulsification cataract surgery. Pre- and postoperative evaluations included corneal topography, visual acuity assessment, and slit-lamp examination. The study adhered to the Declaration of Helsinki, with informed consent obtained from all participants

This prospective, multicenter study included patients aged 50-85 years with corneal astigmatism of 0.75-3.00 D. Exclusion criteria were irregular astigmatism, corneal pathology, moderate-to-severe dry eye, previous refractive surgery, mature/intumescent cataracts, and retinal diseases. Evaluations at baseline, 1, and 3 months included corneal topography and visual acuity. Arcuate keratotomies were performed with the Victus femtosecond laser using the Castrop nomogram. Astigmatic outcomes were analyzed using Alpins’ method, including CI, SI, ME, and vector analysis of TIA/SIA to assess correction accuracy. Statistical analysis included Student’s t-test and ANOVA.

A total of 80 eyes were included. Preoperatively, mean refractive astigmatism was 1.95±0.73 D and topographic astigmatism 1.87±0.63 D. At 1 month, refractive astigmatism decreased to 0.79±0.41 D and topographic astigmatism to 0.67±0.36 D. At 3 months, refractive astigmatism was 0.83±0.35 D and topographic astigmatism 0.91±0.22 D, with no significant differences between WTR, ATR, and oblique astigmatism groups. Alpins analysis showed a Correction Index of 0.64±0.29, indicating a tendency for undercorrection. TIA was 2.02 D, while SIA averaged 1.28 D. At 3 months, 91% had UCVA ≥20/30, 58% ≥20/25, and 32% reached 20/20. No intraoperative complications were observed. 10% reported mild postoperative pain.

Femtosecond laser-assisted arcuate keratotomy combined with cataract surgery effectively reduces moderate corneal astigmatism, improving uncorrected visual acuity. At 1 month, refractive astigmatism decreased to 0.79±0.41 D and topographic astigmatism to 0.67±0.36 D, stabilizing at 0.83±0.35 D and 0.91±0.22 D at 3 months, with 91% achieving UCVA ≥20/30. Alpins analysis showed a Correction Index of 0.64, indicating a tendency for undercorrection. No differences were found between WTR, ATR, and oblique astigmatism. The procedure had no intraoperative complications, 10% reported mild pain, and no significant adverse effects at 3 months. These findings support its safety and efficacy for astigmatism correction in cataract surgery.