Arcuate keratotomy infiltration following uneventful femtosecond laser assisted cataract surgery

An 84-year-old gentleman underwent uneventful femtolaser-assisted cataract surgery (FLACS) with an arcuate keratotomy (AK) in the left eye. On the 18th post-operative day, a corneal infiltrate developed involving the AK. Staphylococcus epidermidis was the organism isolated on culture. The infiltrate resolved with topical fortified vancomycin and amikacin eyedrops, and the patient regained a visual acuity of 6/6 after 12 weeks. This is the first case from south-east Asia reported in the literature of an infective infiltrate along a femtosecond laser AK. We propose strict peri-operative recommendations to be followed to prevent and treat such infections.

Long-term Results of Arcuate Keratotomy in Femtosecond Laser-assisted Cataract Surgery

PURPOSE: To investigate the long-term follow-up results of arcuate keratotomy in femtosecond laser-assisted cataract surgery. METHODS: The medical records of 78 patients (99 eyes) with corneal astigmatism >0.5 diopters (D) who underwent arcuate keratotomy concurrent with femtosecond laser-assisted cataract surgery were retrospectively reviewed. Uncorrected and corrected visual acuities and keratometric and higher order aberration outcomes were compared preoperatively and 2 years postoperatively. RESULTS: The mean uncorrected visual acuities and corrected visual acuities changed from 0.55 ± 0.31 D and 0.33 ± 0.26 D, preoperatively to 0.13 ± 0.19 D and 0.07 ± 0.09 D, 2 years postoperatively. The mean preoperative corneal astigmatism was −1.15 ± 0.66 D. This was reduced to −0.79 ± 0.38 D at 1–2 days after surgery (p < 0.001), followed by no significant change for 2 years. The mean target-induced astigmatism was 1.15 ± 0.66 D preoperatively, and the mean surgically-induced astigmatism and difference vector were 0.69 ± 0.43 D and 0.83 ± 0.48 D, 2 years postoperatively. The mean correction index was 0.68 ± 0.45, 2 years postoperatively. There was no significant difference in higher order aberrations except 4 mm and 6 mm total higher order aberrations and 6 mm trefoil between preoperatively and 2 years postoperatively. CONCLUSIONS: Arcuate keratotomy concurrent with femtosecond laser-assisted cataract surgery is a safe and effective way to reduce corneal astigmatism which remained stable over 2 years of follow-up with below moderate astigmatism.

The Reduction of the Postkeratoplasty Astigmatism by Excimer Laser and Diamond Knife Procedure

PURPOSE: To evaluate the efficacy of excimer laser PRK (PAK) and arcuate keratotomy (AK) for correction of post-keratoplasty astigmatism. METHODS: We performed AK in 13 patients and PAK in 8 patients who had astigmatism over 3.5 D, and who could not wear contact lens or spectacles. We follow up patients in early phase (1~3 months) and late phase (6~12 months) after operation. Net change in astigmatic magnitude , uncorrected visual acuity, and best corrected visual acuity were examined. Surgery-induced astigmatism was calculated by bector anaysis method. RESULTS: Mean preoperative astigmatism in AK patients was 8.23+/-3.25 D and in PAK patients was 7.84+/-1.58 D. Astigmatic magnitude was decreased 61.2% in early phase, 58.3% in late phase in AK patients and decreased 51.4% in early phase, 41.2% in late phase in PAK patients. Post operative astigmatic axis was changed within 30 degrees 76.9% in early phase, 61.5% in late phase in AK, and 50% in early phase, 37.5% in late phase in PAK. Postoperative uncorrected visual acuity showed stastically significant improvement in early and late phase in AK patients and late phase in PAK patients. Postoprative best corrected visual acuity improved 53.8% in AK patients and 50% in PAK patients above 2 Snellen chart lines, but both was not stastically significant. Postoperative complication was mild haze not interfering refraction and visual acuity in 5 eyes of PAK. CONCLUSIONS: AK corrected astigmatsm and visual acuity more rapidly than PAK in early phase, but more undercorrected in late phase. Mild haze was developed in PAK. But AK and PAK show nearly same astigmatic and visual correction results in conclusion.

Arcuate Keratotomy for Astigmatism after Keratoplasty and Advanced Vector Analysis

To evaluate the safety and efficacy of arcuate keratotomy(AK) for correction of high postkeratoplasty astigmatism, we performed AK in 10 patients(11 eyes) who unable to wear contact lens or spectacles, and analysed surgical outcome with vector-corrected analysis and the polar values. A total reduction of 62% in keratometric cylinder was achieved with AK, and average pre- and postoperative keratometric cylinder were 6.00D and 2.27D respectively. The postoperative best corrected visual acuity with spectacle were between o.5 and 1.0 and showed a statistically significant improvement. One eye developed overcorrection requiring compression sutures and another eye underwent a redeepening procedure due to undercorrection. Intraoperative microperforation occured in one eye. With a definition of ` 2theta of 2x(Axis of vector corrected astigmatism - Axis of preoperative astigmatism)`, we found out that actual values of vectorcorrected astigmatism are the same as the polar values in 2-dimensional vector field. Therefore it is understood that the analysis of polar values and vector analysis are the same method for the evaluation of surgically-induced astigmatism. With the vector analysis of surgical outcomes in our patients, AK is ans very simple and effective procedure for the correction of high astigmatism following deratoplasty.