Correction of high astigmatism with astigmatic keratotomy combined with laser in situ keratomileusis

To evaluate the efficacy, predictability, and stability of a combined procedure, arcuate keratotomy and laser in situ keratomileusis (LASIK), for the correction of high astigmatism.

Instituto de Microcirugía Ocular (IMO), Barcelona, Spain.

Fifteen eyes of 11 patients with naturally occurring astigmatism (NOA) (86. 66%) or surgically induced astigmatism (SIA) (13.34%) between -3.00 and -8.00 diopters (D) who had astigmatic keratotomy were studied. The patients had a secondary procedure, LASIK, to correct the residual refractive error.

Mean baseline spherical equivalent refraction was -2.47 D +/- 3.69 (SD) and mean refractive cylinder, -4.59 +/- 1.66 D. Twelve months after LASIK, mean spherical equivalent was -0.09 +/- 1.50 D and the mean refractive cylinder, -1. 21 +/- 1.07 D. The mean cylindrical correction attempted in the NOA group was -4.05 +/- 1.19 D and in the SIA group, -7.00 +/- 1.41 D. Postoperatively, the values were -1.50 +/- 1.17 D and -1.62 +/- 0.17 D, respectively. Twelve months after LASIK, the uncorrected visual acuity (UCVA) was 0.5 +/- 0.1. The UCVA in the NOA group (0.50 +/- 0. 08) was better than in the SIA group (0.32 +/- 0.10). The efficacy index was 0.96 overall. Best corrected visual acuity deteriorated by 1 Snellen line in 1 case (6.6%) but improved by 1 and 2 Snellen lines in 4 cases (26.6%) and 2 cases (13.3%), respectively. All procedures were completed without adverse reactions intraoperatively or postoperatively.

This combined technique was effective in the treatment of high astigmatism, with excellent results compared with the results of each procedure alone. Because of its high predictability, we strongly recommend the technique in cases with astigmatism higher than 3.0 D, particularly in those with astigmatism higher than 5.0 D.