Effectiveness, Stability, and Influence Factors of Femtosecond Laser-Assisted Arcuate Keratotomy in Cataract Surgery: A Systematic Review and Meta-Analysis

Abstract

Purpose: This study aimed to evaluate the effectiveness, stability, and influencing factors of femtosecond laser-assisted arcuate keratotomy (FSAK) performed during cataract surgery for correcting corneal astigmatism (CA).

Methods: A systematic literature review was conducted to identify clinical trials adopting a pre-post study design. Data sources included electronic databases such as PubMed, Scopus, Web of Science, and Embase. Corneal astigmatism was assessed preoperatively and at multiple postoperative intervals: 1 month, 3 months, 6 months, and 1 year. Comparative analyses were conducted to determine the efficacy and stability over time. Subgroup analyses of CA reduction and absolute angle of error were performed based on potential influence factors including the type, depth, diameter, and platform of FSAK, magnitude and type of preoperative CA, and area of the study. Statistical analyses were performed using Review Manager 5.4.

Design: Systematic review and meta-analysis.

Results: Of the 40 articles initially identified, 20 met the final inclusion criteria. Follow-up durations ranged from 1 month to 2 years. Significant reduction in CA postoperative were observed at 1 month, 3 months, 6 months, and 1 year after surgery (mean difference [MD] = -0.55 D, -0.66 D, -0.43 D, and -0.67 D, respectively; all P < .02). CA between different postoperative time points were not significant (all P > .20). Subgroup analysis did not address the high heterogeneity. However, differences of CA reduction between subgroups based on type, depth, diameter, and platform of FSAK were significant. Penetrating FSAK, deeper incision, optical diameter at 8.5 mm were shown to introduce higher CA reduction (P = .005, .02, < .001, respectively). The effect achieved by different laser platforms were significantly different (P = .0002).

Conclusions: FSAK performed during cataract surgery effectively reduces corneal astigmatism, with stability observed from 1 month to 1 year postoperatively. The corrective performance is closely related to type, depth, diameter, and platform of FSAK. This study was supported by the National Natural Science Foundation of China (Grant No. 82171039 and No. 82301191).

Registration number: PROSPERO CRD 42024504481).