Arcuate keratotomy: an option for astigmatism correction after laser in situ keratomileusis

The purpose of this study was to report arcuate keratotomy (AK) as a treatment for post-laser in situ keratomileusis astigmatism arising from incorrect axis treatment.

A 52-year-old woman presented with decreased vision in her left eye. Three months previously, the patient had undergone laser in situ keratomileusis in her left eye with incorrect axis treatment. All potential options were discussed in detail with the patient. After consideration, she proceeded with AK as a tissue-sparing maneuver and planned to evaluate other options in the future.

The patient received a pair of 60-degree arcuate incisions at a 7-mm optical zone. On the first postoperative visit, dramatic improvement in uncorrected visual acuity was noted along with the reduction of ghosting and visual blur. The refractive error was +0.50-1.00 x 165 degrees . At the final 1-year follow up, uncorrected visual acuity was 20/25. The residual refractive error was +0.50-0.75 x 173 degrees .

To the best of our knowledge, this is the first reported case of AK in a patient with high astigmatism resulting from incorrect axis treatment during Laser in situ keratomileusis. Visual recovery is rapid and refractive changes are stable. For refractive surgeons familiar with AK, this tissue neutral surgical approach may be a first choice option to improve uncorrected visual acuity and reduce unwanted and disabling optical effects secondary to high astigmatism.