Refractive outcomes after limbal relaxing incisions or femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery

Abstract

Purpose: To compare the results of manual limbal relaxing incisions (LRIs) performed during conventional phacoemulsification surgery with those of nonpenetrating femtosecond laser arcuate keratotomies performed during femtosecond laser-assisted cataract surgery to manage corneal astigmatism.

Setting: Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.

Design: Randomized case-controlled trial.

Methods: This was a secondary outcome of a randomized controlled trial comparing 400 patients treated with conventional phacoemulsification surgery or femtosecond laser-assisted cataract surgery. All patients with corneal astigmatism greater than 0.9 diopter (D) were offered LRIs or femtosecond laser arcuate keratotomy based on the original randomization. Visual acuity, postoperative refraction, and corneal topography were recorded 4 weeks postoperatively. Vector analysis was performed using the Alpins method.

Results: Fifty-one eyes of 51 patients received LRIs, and 53 eyes of 53 patients received femtosecond arcuate keratotomies. The mean target induced astigmatism was 1.50 D and 1.38 D, respectively, with 1.02 D and 1.23 D surgically induced astigmatism (P = .21), resulting in the femtosecond arcuate keratotomy group having a smaller difference vector (1.17 D versus 0.89 D; P = .02) and a greater correction index (0.48 versus 0.73; P = .02). Forty-four percent of patients in the femtosecond arcuate keratotomy group and 20% in the LRI group attained a postoperative cylinder of less than 0.50 D (P = .01).

Conclusions: The femtosecond arcuate keratotomy group achieved a higher correction index and a smaller difference vector. The femtosecond arcuate keratotomy patients showed less postoperative cylinder than LRI patients.