Analysis of Factors Affecting the Astigmatic Correction Outcomes of Keratorefractive Lenticule Extraction Surgery

Background: Keratorefractive Lenticule Extraction (KLEx) is an emerging flap-free surgical technique for the correction of myopic astigmatism. However, postoperative astigmatic accuracy remains variable. This study aimed to identify clinical and surgical factors that influence the outcomes of astigmatic correction following KLEx. Methods: A total of 98 patients with myopic astigmatism underwent KLEx. Manifest refraction was evaluated at three months postoperatively. Astigmatic outcomes were assessed using Alpins vector analysis. Multivariate linear and logistic regression models were used to determine associations between preoperative and intraoperative variables-such as age, eye laterality, tear film quality, sphere-to-cylinder ratio, and preoperative cylinder-and astigmatic correction parameters, including residual cylinder, correction index, magnitude of error, and angle of error. Results: Older age was associated with larger residual cylinder and angle of error. Eye laterality and tear film quality significantly influenced correction accuracy. A higher sphere-to-cylinder ratio and preoperative cylinder were also predictive of astigmatic correction performance. Conclusions: The accuracy of astigmatic correction in KLEx is significantly influenced by multiple clinical and surgical factors. Awareness of these predictors may guide surgical planning and improve refractive outcomes.