Femtosecond laser-assisted keratotomy

To review the recent literature on femtosecond laser-assisted astigmatic keratotomy and its applications to naturally occurring as well as postoperative astigmatism in multiple settings.

Femtosecond laser technology has improved the safety and efficacy of astigmatic keratotomy in the treatment of astigmatism. Intrastromal femtosecond astigmatic keratotomy (ISAK) may have even lower complication rates, though long-term results are still being established. Femtosecond laser-assisted keratotomy (FSAK) in the surgical setting, such as at the time of or after cataract surgery, keratoplasty, and glaucoma surgery, has been investigated with overall good results. There have been some reports of overcorrection and undercorrection of astigmatism, particularly in the setting of high and nonorthogonal astigmatism. Further refinement of nomograms in these settings is indicated. Complications such as full thickness FSAK and ISAK incisions are rare but have been reported, and may be mitigated by the integration of dynamic optical coherence tomography (OCT) into femtosecond laser systems.

FSAK is an effective and safe way to correct astigmatism. These procedures have some advantages over manual astigmatic keratotomy, including increased accuracy of incision depth and placement. As nomograms are refined and technologies such as dynamic OCT are further incorporated into femtosecond systems, results are likely to continue improving.