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Pseudophakic astigmatism reduction with femtosecond laser-assisted corneal arcuate incisions: a pilot study.

ABSTRACT: PURPOSE:The aim of this study was to assess the effectiveness of the Verion-LenSx guided arcuate incision technique to reduce refractive astigmatism in a pseudophakic population. PATIENTS AND METHODS:A prospective single-arm study was conducted in which one or both eyes of subjects required reduction of 1.0-2.0 D of refractive astigmatism after previous cataract surgery or refractive lens exchange. The surgeon used the refractive cylinder in the eye and the Woodcock astigmatism nomogram for preoperative planning, while the LenSx femtosecond laser with the Verion Image Guided System was used to create all arcuate incisions. The primary outcome measure was the uncorrected monocular distance visual acuity (UCVA). Secondary outcome measures included the change in corneal astigmatism, the change in refractive astigmatism, the best-corrected visual acuity and spectacle independence at distance from preoperative stage to 1 month and 2 months postoperatively. RESULTS:Twenty-eight eyes of 18 subjects were treated. The best-corrected visual acuity at the 2-month postoperative (PO) stage was not statistically significantly different from the preoperative visual acuity (0.02 logarithm of the minimum angle of resolution [logMAR] in both cases, P>0.05). Uncorrected visual acuity was statistically significantly better at the 2-month PO stage relative to the preoperative value (0.14 versus 0.34 logMAR, P<0.01). The mean change in refractive cylinder from the preoperative stage to the 2-month PO stage was 1.0 D. At the 2-month PO stage, two-thirds of the subjects (12/18) reported that they did not use glasses for distance vision and that their spectacle use for distance vision at 2 months was "lower" or "much lower" than the preoperative stage; in 71% of eyes (20/28), the residual refractive cylinder was ?0.50 D. Vector changes in keratometric astigmatism were weakly associated with changes in refractive cylinder. CONCLUSION:Arcuate incisions made with a femtosecond laser to treat moderate levels of residual refractive astigmatism after previous cataract surgery may reduce dependence on spectacles for distance vision.

SUBMITTER: Blehm C

PROVIDER: S-EPMC5271394 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Pseudophakic astigmatism reduction with femtosecond laser-assisted corneal arcuate incisions: a pilot study.

Blehm Clayton C Potvin Richard R

Clinical ophthalmology (Auckland, N.Z.) 20170123

<h4>Purpose</h4>The aim of this study was to assess the effectiveness of the Verion-LenSx guided arcuate incision technique to reduce refractive astigmatism in a pseudophakic population.<h4>Patients and methods</h4>A prospective single-arm study was conducted in which one or both eyes of subjects required reduction of 1.0-2.0 D of refractive astigmatism after previous cataract surgery or refractive lens exchange. The surgeon used the refractive cylinder in the eye and the Woodcock astigmatism no ...[more]

PMID: 28176960

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Project description:PurposeTo compare the relative effectiveness of Verion-LenSx guided femtosecond arcuate incisions and manual incisions in reducing postoperative refractive astigmatism.Patients and methodsThis was a contralateral eye, prospective study that included subjects with 0.50 D to 1.75 D of corneal astigmatism who wanted less refractive astigmatism post cataract surgery. The surgeon used anterior keratometry and the Woodcock astigmatism nomogram for preoperative planning, while the LenSx femtosecond laser with the Verion Image Guided System was used to create all laser arcuate incisions. Manual incisions were planned using the Donnenfeld nomogram and made with a fixed-depth diamond knife. The primary outcome measure was the residual refractive astigmatism at 3 months postoperative. Secondary outcome measures included the manifest refraction, uncorrected distance visual acuity and the change in corneal astigmatism from 1 to 3 months postoperative.ResultsForty-one subjects were successfully enrolled in the study, with data from 38 subjects available at 3 months. There were no statistically significant differences in refractive astigmatism, corneal astigmatism, uncorrected distance visual acuity or manifest refraction between the Manual and Femto groups at either 1 month or 3 months. Significant changes in refractive and corneal astigmatism were noted between 1 months and 3 months. Ninety percent of eyes in both groups had ≤0.50 D of refractive astigmatism at 3 months. Two minor non-serious adverse events (full-thickness incisions of the cornea) occurred in two eyes of two different subjects in the Manual group; they were resolved without incident.ConclusionLaser arcuate incisions appear to be an effective means of reducing postoperative refractive astigmatism at the time of cataract surgery. No significant clinical differences were observed between incisions made manually and those made with an image-guided femto-second laser system. The lower number of minor adverse events experienced with the femtosecond laser system is an apparent advantage.

Project description:BackgroundCorneal refractive surgery for myopia results in an oblate shift with increased postoperative aberrations inversely affecting the quality of vision. Aspheric ablation profiles have been introduced to minimize such a problem. The aim of this study was to compare changes in corneal asphericity, central and mid-peripheral pachymetry between the Q-value customized and the wavefront-optimized (WFO) ablation profiles.MethodsA prospective, comparative non-randomized fellow eye study was conducted. Eighty eyes of 40 eligible patients underwent femtosecond laser-assisted laser in situ keratomileusis for myopia and myopic astigmatism. In each patient, the more myopic eye was included in the custom-Q ablation experimental group and the other less myopic eye was included in the WFO control group. For the custom-Q group, the target asphericity was set to the preoperative Q-value. Corneal asphericity, central and mid-peripheral pachymetric changes and the root mean square of corneal higher-order aberrations (RMSh) were assessed 6 months following surgery. Visual and refractive outcomes were also evaluated in both platforms 6 months postoperatively.ResultsThe mean preoperative refractive spherical equivalent was significantly more myopic in the custom-Q group than in the WFO group (P = 0.001). The mean Q-value changed from - 0.2 ± 0.1 to 0.6 ± 0.7 and from - 0.2 ± 0.1 to 0.4 ± 0.5 in the custom-Q and WFO groups, respectively. The oblate shift in corneal asphericity was not significantly different between both treatment groups (P = 0.094). The mean ablation depth at the pupillary center was significantly greater in the custom-Q group (P = 0.011), while there was no significant difference at the mid-peripheral pachymetry (P = 0.256). The RMSh significantly increased in both treatment profiles (P < 0.001) with no significant difference between the two groups (P = 0.06). The uncorrected distance visual acuity (UDVA) and the manifest refraction spherical equivalents (MRSE) significantly improved in both treatment groups (P < 0.001).ConclusionsThe custom-Q treatment profile with target asphericity set at the preoperative Q-value achieved comparable outcomes vs. the WFO profile in terms of postoperative corneal asphericity and mid-peripheral pachymetry despite the greater amount of ablation, the smaller optical zone, and the resulting increase in postoperative corneal flattening in the custom-Q group. Trial registration (Clinicaltrials.gov): NCT04738903, 4 February 2021- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04738903.

Dataset Information

Pseudophakic astigmatism reduction with femtosecond laser-assisted corneal arcuate incisions: a pilot study.

Publications

Pseudophakic astigmatism reduction with femtosecond laser-assisted corneal arcuate incisions: a pilot study.

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