Two-year outcomes after full-thickness astigmatic keratotomy combined with small-incision lenticule extraction for...

To evaluate clinical outcomes after full-thickness astigmatic keratotomy (FTAK) combined with small-incision lenticule extraction (SMILE) in eyes with high astigmatism.

This study comprised 75 eyes of 43 patients with over 4.0 diopters (D) of astigmatism who were treated with SMILE after FTAK. Visual acuities and refractive measurements were evaluated at 1 month after FTAK, and 1, 6, 12, and 24 months after SMILE. Vector analysis of the astigmatic changes was performed using the Alpins method.

Twenty-four months after the combined procedure, the average spherical equivalent was reduced from - 6.56 ± 2.38 D to - 0.36 ± 0.42 D (p < 0.001). The uncorrected and corrected distance visual acuities improved from 1.54 ± 5.53 to - 0.02 ± 0.09 and from - 0.03 ± 0.07 D to - 0.07 ± 0.08 D (both p < 0.001), respectively. The preoperative mean astigmatism was - 5.48 ± 1.17 D, which was reduced to - 2.27 ± 0.97 D and - 0.34 ± 0.26 D at 1 month after FTAK and 24 months after SMILE, respectively (p < 0.001). The surgically-induced astigmatism after FTAK, SMILE, and FTAK and SMILE combined was 3.38 ± 1.18 D, 2.22 ± 0.84 D, and 5.39 ± 1.20 D, respectively. Furthermore, the correction index of FTAK, SMILE, and FTAK and SMILE combined was 0.63 ± 0.17, 0.90 ± 0.40, and 0.98 ± 0.06, respectively. There were no intraoperative or postoperative complications.

Our surgical procedure combining FTAK and SMILE showed good and stable clinical outcomes during two-year follow-up for the treatment of high astigmatism.