Femtosecond laser assisted phacoemulsification plus IOL implant: toric IOL vs. astigmatic keratotomy

To compare the clinical outcomes of femtosecond laser-assisted cataract surgery (FSLACS) with astigmatic keratotomy (AK) versus toric intraocular lens (IOL_t) implantation for astigmatism correction.

Retrospective comparative case series.

60 eyes (45 IOL_t cases and 15 AK cases) with patient's mean age of 61.46 ± 12.84 years underwent FSLACS with astigmatic correction. Pre and post-operative evaluations included autorefractometry, corneal topography, IOL Master analysis, and assessment of total ocular astigmatism (OA_tot), anterior/posterior/total corneal astigmatism (CA_ant/CA_post/CA_tot), corneal higher-order aberrations (HOAs), vector analysis, and best-corrected/uncorrected distant visual acuity (BCVA; UDVA; LogMAR). The average follow-up period was 16.29 ± 11.15 months.

In term of OA_tot as demonstrated by polar plots, significant reductions were observed in both the IOL_t and the AK groups (p < 0.001). In regard to CA_ant, a statistically significant change was observed in the AK group. No significant change was noted in the IOL_t group. In view of CA_post, there was no statistically significant difference in CA_post for either the IOL_t or AK groups, indicating stability of the posterior corneal surface. As for CA_tot, the AK group showed a significant pre to post-operative change (p < 0.001). No significance was found in the IOL_t group. Likewise, corneal HOAs remained stable in IOL_t but significantly increased in AK (p < 0.01). This is associated with a significant intergroup difference of p < 0.001. Vector astigmatism analysis utilizing Double Angle Vector Diagrams to show that TIA/SIA/DV/CI for the IOL_t group and for the AK group. Vector astigmatism analysis implied that there was no significant difference in target/surgery induced astigmatism (TIA/SIA) between groups. BCVA (LogMAR) improved significantly in both groups [IOL_t: 0.40 (0.40, 0.50) to 0.10 (0.00, 0.10); AK: 0.40 (0.40, 0.50) to 0.10 (0.10, 0.15); both p < 0.001]. There is with no significant difference between both groups (p = 0.49).

FSLACS with toric IOL implantation offers an effective and more stable astigmatism correction without increasing HOAs, but also having similar visual outcome improvement, when compared to AK's astigmatism correction.