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Femtosecond laser arcuate keratotomy for the correction of postkeratoplasty high astigmatism in keratoconus.

BACKGROUND: Astigmatism is the leading complication in visual recovery after penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK); in this study, we evaluated the outcome of femtosecond laser arcuate keratotomy (FLAK) after DALK and PKP in Iranian keratoconic patients.

MATERIALS AND METHODS: In this prospective interventional case series, refractive and keratometric predictability, efficacy, and complications of FLAK for postkeratoplasty astigmatism in keratoconus were evaluated; 23 eyes of 23 consecutive patients (mean age of 32.43 ± 9.11 years) with high astigmatism were enrolled. The femtosecond laser performed paired 90°-angled arcuate incisions.

RESULTS: Mean logarithm of the minimum angle of resolution of corrected and uncorrected visual acuity improved from preoperative values of 0.30 ± 0.18 and 0.85 ± 0.32 to 6-month values of 0.19 ± 0.17 and 0.65 ± 0.33, respectively ( P < 0.05). Mean subjective astigmatism was 7.79 ± 2.64 diopter (D) preoperatively and 3.69 ± 2.25D at 6-month after surgery ( P < 0.05). Surgically induced astigmatism was 9.27 ± 5.00D. Mean refractive spherical equivalent showed no significant ( P = 0.69) hyperopic shift from - 4.21 ± 4.84D preoperatively to - 2.16 ± 6.09D postoperatively. Two (8.7%) microperforations were observed.

CONCLUSION: FLAK is a relatively safe and effective method for the treatment of postkeratoplasty astigmatism.

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