Astigmatic keratotomy combined with myopic keratomileusis in situ for compound myopic astigmatism

Myopic keratomileusis in situ by an automated microkeratome corrects myopia but not astigmatism, which is traditionally corrected by astigmatic keratotomy months after keratomileusis. We developed a technique for simultaneously correcting astigmatism and severe myopia, and examined its effectiveness in a retrospective case-control study.

Thirty-four eyes (23 patients) underwent myopic keratomileusis in situ combined with one or two arcuate keratotomy incisions performed after the refractive cut, in the bed of the primary keratectomy flap. The myopic keratomileusis control group consisted of 34 matched eyes (30 patients) undergoing keratomileusis without astigmatic keratotomy. The astigmatic control group consisted of 117 unmatched eyes (85 patients) undergoing astigmatic keratotomy combined with radial keratotomy.

Mean refractive astigmatism in the study group decreased from 2.4 diopters (range, 1.0 to 4.0 diopters) preoperatively to 1.7 diopters (range, 1.0 to 4.0 diopters) at three months postoperatively, and increased by 0.4 diopter in the myopic keratomileusis control group at three months postoperatively (P < .005). Eighteen of 27 eyes in the study group showed decreased refractive astigmatism compared with ten of 34 eyes in the myopic keratomileusis control group (P < .0001). Combining astigmatic keratotomy with myopic keratomileusis produced 0.2 +/- 0.9 diopter less astigmatic correction than that expected from the astigmatic control group. One of 27 eyes lost two or more lines of best spectacle-corrected visual acuity at the three-month postoperative visit. No eye lost two or more lines of best spectacle-corrected visual acuity at postoperative month 6.

Eyes with substantial preoperative refractive astigmatism that undergo myopic keratomileusis in situ may benefit from simultaneous astigmatic keratotomy to reduce residual post-operative refractive astigmatism.