Staged Femtosecond Intrastromal Arcuate Keratotomy Followed By Excimer Laser Correction For High Myopia With Astigmatism In Thin Corneas

To evaluate the safety, effectiveness, and refractive and topographic outcomes of staged femtosecond intrastromal arcuate keratotomy followed by excimer laser correction in patients with high myopia and astigmatism with thin corneas, aiming to reduce tissue ablation and improve visual outcomes.

Saif-Optima Eye Clinic, Tashkent, Uzbekistan.

This prospective study included 25 patients (39 eyes) aged 20–35 years with high myopia and corneal astigmatism and thin corneas (mean CCT 480 µm, minimum 449 µm). All patients underwent staged treatment. Stage I consisted of femtosecond intrastromal arcuate keratotomy (80–85% stromal depth) using a femtosecond laser. After 6 months, Stage II was performed to correct residual refractive error using Trans-PRK or FemtoLASIK. Visual acuity, spherical equivalent (SE), astigmatism, and corneal topographic parameters were evaluated preoperatively and postoperatively. Follow-up was up to 3 years.

Mean spherical equivalent improved significantly from −5.9 D preoperatively to −0.23 D after excimer laser correction. Mean UCVA improved from 0.09 to 0.62. Mean astigmatism decreased from −4.25 D preoperatively to −1.84 D after arcuate keratotomy and further to −0.73 D after excimer correction. Refractive accuracy showed 40% of eyes within ±1.0 D, 10% within ±0.5 D, and 30% with residual cylinder ≤0.75 D. Corneal topographic stability was observed, and no cases of ectasia occurred during follow-up.

Staged femtosecond intrastromal arcuate keratotomy followed by excimer laser correction is a safe, effective, and tissue-preserving strategy for managing high myopia with astigmatism in thin corneas, providing stable refractive and topographic outcomes.