IntraLase-Enabled Astigmatic Keratotomy for Postkeratoplasty Astigmatism

Department of Ophthalmology, Toronto Western Hospital, Donald K. Johnson Eye Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
American Journal of Ophthalmology (Impact Factor: 3.87). 09/2008; 146(6):897-904.e1. DOI: 10.1016/j.ajo.2008.07.004
Source: PubMed


To report on the outcomes of IntraLase-enabled astigmatic keratotomy (IEAK) and to compare it with manual astigmatic keratotomy (AK) for the management of postkeratoplasty astigmatism.
Retrospective, comparative case series.
Forty eyes of 39 patients treated at a cornea clinic at the Toronto Western Hospital were included. Twenty eyes underwent manual AK and 20 eyes underwent IEAK. The main outcome measures included preoperative and postoperative manifest refraction, uncorrected and best-corrected visual acuity (UCVA, BCVA), corneal topography, high-order ocular aberrations, and complications.
In the manual AK group, UCVA (logarithm of the minimum angle of resolution) improved from 1.08 +/- 0.29 before surgery to 0.93 +/- 0.45 after surgery (P = .09), and in the IEAK group, UCVA improved from 1.14 +/- 0.42 before surgery to 0.82 +/- 0.44 after the procedure (P = .004). BCVA improved from 0.63 +/- 0.40 to 0.44 +/- 0.38 (manual AK; P = .16) and from 0.52 +/- 0.38 to 0.29 +/- 0.26 (IEAK; P = .01), respectively. Mean cylinder reduction was 3.23 +/- 4.69 diopters in the manual AK group and 4.26 +/- 1.72 diopters in the IEAK group (P = .36). Two eyes in each group lost one line of BCVA. Three patients (15%) in the manual AK group had corneal perforation and required resuturing of the AK wound (P = .23) Overcorrection occurred at a similar rate in the two groups.
Treatment of postkeratoplasty astigmatism with IntraLase is a safe and effective surgical procedure and resulted in a significant improvement in UCVA and BCVA compared with manual AK. A larger sample series is needed to refine further this new technique of AK and to compare it with accepted manual techniques.

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    • "Management of post-keratoplasty cataract with high astigmatism consists of safe removal of cataract and effective treatment of astigmatism by various methods like spectacles, contact lenses, arcuate keratotomy with compression sutures or astigmatic keratotomy with femtosecond laser,[1] photorefractive keratectomy, LASIK,[2] intracorneal ring segments, and toric IOLs. At present, phacoemulsification with toric IOL implantation has become the preferred way to manage such cases.[345678] "
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    ABSTRACT: We report a case of 18-year-old male who has undergone phacoemulsification with implantation of toric IOL (AcrySof IQ SN6AT9) after fixation of lens capsule with Cionni's capsular tension ring (CTR) for subluxated traumatic cataract with high astigmatism after deep anterior lamellar keratoplasty (DALK). He underwent right eye DALK for advanced keratoconus four years earlier. He had history of trauma one year later with displaced clear crystalline lens into anterior chamber and graft dehiscence, which was repaired successfully. The graft survived, but patient developed cataract with subluxated lens, for which phacoemulsification with implantation of toric IOL was done. Serial topography showed regular corneal astigmatism of -5.50 diopter (K 1 42.75 D @130°, K 2 48.25 D @40°). At 10-month follow-up, the patient has BCVA 20/30 with + 0.75 DS/- 1.75 DC @ 110°. The capsular bag is quite stable with well-centered IOL. Combination of Cionni's ring with toric IOL could be a good option to manage such complex cases.
    No preview · Article · Jul 2014 · Indian Journal of Ophthalmology
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    • "Recently, limbal femtosecond laser-assisted intrastromal arcuate keratotomy has been used for corneal astigmatisms of 1.50 ± 0.47 D [22]. However, the results of this procedure are unpredictable or are associated with complications [29] [30]. "
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    ABSTRACT: Purpose. To analyze the prevalence and presentation patterns of corneal astigmatism in cataract surgery candidates in a teaching hospital in northern China. Methods. From May 1, 2012, to April 30, 2013, partial coherence interferometry (IOLMaster) measurements of all qualified cataract surgery candidates were retrospectively collected and analyzed. Results. The study evaluated 12,449 eyes from 6,908 patients with a mean age of 69.80 ± 11.15 (SD) years. The corneal astigmatism was 0.5 diopters (D) or less in 20.76% of eyes, 1.0 D or more in 47.27% of eyes, 2.0 D or more in 13.16% of eyes, and 3.0 D or more in 3.75% of eyes. With-the-rule astigmatism was found in 30.36% of eyes, while against-the-rule was found in 52.41% of eyes. The percentage of against-the-rule astigmatism increased with age. Conclusion. Our study showed that almost one-half of preoperative eyes (47.27%) in northern China have a corneal astigmatism of 1.0 D or more, indicating that more surgical techniques or toric IOLs are needed to achieve better visual rehabilitation.
    Full-text · Article · Jun 2014 · Journal of Ophthalmology
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    • "Phacoemulsification with implantation of foldable toric intraocular lens (IOL) has become the preferred management option in patients with high corneal astigmatism with coexistent cataract. Various treatment options available for patients with post-keratoplasty high corneal astigmatism in patients with coexistent cataract are spectacles, toric contact lenses, rigid gas permeable lenses,[1] arcuate keratotomy with compression sutures[2] or astigmatic keratotomy with femtosecond laser,[3] photorefractive keratectomy,[4] laser-assisted in situ keratomileusis (LASIK),[56] intracorneal ring segments[7] and presently toric IOLs.[8–12] Artisan[89] and intraocular collamer lens (ICL)[1011] of STAAR Surgicals have been used for the post-keratoplasty high astigmatism. "
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    ABSTRACT: We report a 63-year-old male who had undergone left eye optical penetrating keratoplasty for central leucomatous corneal opacity 10 years earlier. The eye had clear donor graft with residual astigmatism of -6.50 diopter cylinder (DC) at 30°. The patient underwent clear corneal phacoemulsification with implantation of +6.0 D spherical equivalent AcrySof SN60T9 intraocular lens (IOL). Postoperatively, at 10 months, the patient had distance corrected visual acuity of 20/30 with -2.00 DC at 20°. AcrySof toric IOL offers an effective treatment option for post-keratoplasty high corneal astigmatism in patients with cataract.
    Full-text · Article · May 2012 · Indian Journal of Ophthalmology
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