Purpose: To study the astigmatic correction of high post-keratoplasty astigmatism using Femtosecond laser (FSL)-assisted Arcuate Keratotomy (FS-AK). Methods: A prospective interventional cohort study. We enrolled 17 eyes with high degree of irregular astigmatism, scheduled for FS-AK. FSL was used to perform paired arcuate incisions 1.00 mm inside the graft. Patients’ uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and astigmatic change were recorded and followed up to 1 year after surgery. Vector analysis using Alpins’ method was done to analyze the astigmatic correction. Results: FS-AK reduced the refractive astigmatism at final follow-up visit at 12 months (p = 0.0008, repeated-measures analysis of variance [ANOVA]). The procedure improved the UCVA over the follow-up period (p = 0.007, repeated-measures ANOVA), with a similar effect on the BCVA (p = 0.046, repeated-measures ANOVA). There was a mild correlation between the target-induced astigmatism and the surgically induced astigmatism (R2 = 0.245) with a tendency to overcorrect more than under correct the astigmatism. A constant rotational error in the counterclockwise direction was also detected. Conclusions: FS-AK improves the visual outcome and reduces the refractive cylinder in post-penetrating keratoplasty astigmatism. The predictability of astigmatism correction was variable in reducing post-keratoplasty astigmatism. Refinement of the treatment nomogram for such cases is highly recommended.

1.
Riddle
HK
 Jr
,
Parker
DA
,
Price
FW
 Jr
.
Management of postkeratoplasty astigmatism
.
Curr Opin Ophthalmol
.
1998
Aug
;
9
(
4
):
15
28
.
[PubMed]
1040-8738
2.
Szentmáry
N
,
Seitz
B
,
Langenbucher
A
,
Naumann
GO
.
Repeat keratoplasty for correction of high or irregular postkeratoplasty astigmatism in clear corneal grafts
.
Am J Ophthalmol
.
2005
May
;
139
(
5
):
826
30
.
[PubMed]
0002-9394
3.
Fares
U
,
Sarhan
AR
,
Dua
HS
.
Management of post-keratoplasty astigmatism
.
J Cataract Refract Surg
.
2012
Nov
;
38
(
11
):
2029
39
.
[PubMed]
0886-3350
4.
Koffler
BH
,
Smith
VM
.
Corneal topography, arcuate keratotomy, and compression sutures for astigmatism after penetrating keratoplasty
.
J Refract Surg
.
1996
Feb
;
12
(
2
):
S306
9
.
[PubMed]
1081-597X
5.
Javadi
MA
,
Feizi
S
,
Yazdani
S
,
Sharifi
A
,
Sajjadi
H
.
Outcomes of augmented relaxing incisions for postpenetrating keratoplasty astigmatism in keratoconus
.
Cornea
.
2009
Apr
;
28
(
3
):
280
4
.
[PubMed]
0277-3740
6.
Feizi
S
,
Zare
M
.
Current approaches for management of postpenetrating keratoplasty astigmatism
.
J Ophthalmol
.
2011
;
2011
:
708736
.
[PubMed]
2090-004X
7.
Al Sabaani
N
,
Al Malki
S
,
Al Jindan
M
,
Al Assiri
A
,
Al Swailem
S
.
Femtosecond astigmatic keratotomy for postkeratoplasty astigmatism
.
Saudi J Ophthalmol
.
2016
Jul-Sep
;
30
(
3
):
163
8
.
[PubMed]
1319-4534
8.
Hoffart
L
,
Touzeau
O
,
Borderie
V
,
Laroche
L
.
Mechanized astigmatic arcuate keratotomy with the Hanna arcitome for astigmatism after keratoplasty
.
J Cataract Refract Surg
.
2007
May
;
33
(
5
):
862
8
.
[PubMed]
0886-3350
9.
Borderie
VM
,
Touzeau
O
,
Chastang
PJ
,
Laroche
L
.
Surgical correction of postkeratoplasty astigmatism with the Hanna arcitome
.
J Cataract Refract Surg
.
1999
Feb
;
25
(
2
):
205
11
.
[PubMed]
0886-3350
10.
Poole
TR
,
Ficker
LA
.
Astigmatic keratotomy for post-keratoplasty astigmatism
.
J Cataract Refract Surg
.
2006
Jul
;
32
(
7
):
1175
9
.
[PubMed]
0886-3350
11.
Mian
SI
,
Shtein
RM
.
Femtosecond laser-assisted corneal surgery
.
Curr Opin Ophthalmol
.
2007
Jul
;
18
(
4
):
295
9
.
[PubMed]
1040-8738
12.
Kymionis
GD
,
Yoo
SH
,
Ide
T
,
Culbertson
WW
.
Femtosecond-assisted astigmatic keratotomy for post-keratoplasty irregular astigmatism
.
J Cataract Refract Surg
.
2009
Jan
;
35
(
1
):
11
3
.
[PubMed]
0886-3350
13.
Hoffart
L
,
Proust
H
,
Matonti
F
,
Conrath
J
,
Ridings
B
.
Correction of postkeratoplasty astigmatism by femtosecond laser compared with mechanized astigmatic keratotomy
.
Am J Ophthalmol
.
2009
May
;
147
(
5
):
779
87
.
[PubMed]
0002-9394
14.
Hanna
KD
,
Hayward
JM
,
Hagen
KB
,
Simon
G
,
Parel
JM
,
Waring
GO
 3rd
.
Keratotomy for astigmatism using an arcuate keratome
.
Arch Ophthalmol
.
1993
Jul
;
111
(
7
):
998
1004
.
[PubMed]
0003-9950
15.
St Clair
RM
,
Sharma
A
,
Huang
D
,
Yu
F
,
Goldich
Y
,
Rootman
D
, et al
Development of a nomogram for femtosecond laser astigmatic keratotomy for astigmatism after keratoplasty
.
J Cataract Refract Surg
.
2016
Apr
;
42
(
4
):
556
62
.
[PubMed]
0886-3350
16.
Alpins
N
.
Astigmatism analysis by the Alpins method
.
J Cataract Refract Surg
.
2001
Jan
;
27
(
1
):
31
49
.
[PubMed]
0886-3350
17.
Alpins
NA
,
Goggin
M
.
Practical astigmatism analysis for refractive outcomes in cataract and refractive surgery
.
Surv Ophthalmol
.
2004
Jan-Feb
;
49
(
1
):
109
22
.
[PubMed]
0039-6257
18.
Reinstein
DZ
,
Archer
TJ
,
Randleman
JB
.
JRS standard for reporting astigmatism outcomes of refractive surgery
.
J Refract Surg
.
2014
Oct
;
30
(
10
):
654
9
.
[PubMed]
1081-597X
19.
Böhringer
D
,
Dineva
N
,
Maier
P
,
Birnbaum
F
,
Kirschkamp
T
,
Reinhard
T
, et al
Long-term follow-up of astigmatic keratotomy for corneal astigmatism after penetrating keratoplasty
.
Acta Ophthalmol
.
2016
Nov
;
94
(
7
):
e607
11
.
[PubMed]
1755-375X
20.
Nubile
M
,
Carpineto
P
,
Lanzini
M
,
Calienno
R
,
Agnifili
L
,
Ciancaglini
M
, et al
Femtosecond laser arcuate keratotomy for the correction of high astigmatism after keratoplasty
.
Ophthalmology
.
2009
Jun
;
116
(
6
):
1083
92
.
[PubMed]
0161-6420
21.
Fadlallah
A
,
Mehanna
C
,
Saragoussi
JJ
,
Chelala
E
,
Amari
B
,
Legeais
JM
.
Safety and efficacy of femtosecond laser-assisted arcuate keratotomy to treat irregular astigmatism after penetrating keratoplasty
.
J Cataract Refract Surg
.
2015
Jun
;
41
(
6
):
1168
75
.
[PubMed]
0886-3350
22.
Rückl
T
,
Dexl
AK
,
Bachernegg
A
,
Reischl
V
,
Riha
W
,
Ruckhofer
J
, et al
Femtosecond laser-assisted intrastromal arcuate keratotomy to reduce corneal astigmatism
.
J Cataract Refract Surg
.
2013
Apr
;
39
(
4
):
528
38
.
[PubMed]
0886-3350
23.
Faktorovich
EG
,
Maloney
RK
,
Price
FW
 Jr
;
THE ARC-T STUDY Group
.
Effect of astigmatic keratotomy on spherical equivalent: results of the Astigmatism Reduction Clinical Trial
.
Am J Ophthalmol
.
1999
Mar
;
127
(
3
):
260
9
.
[PubMed]
0002-9394
24.
Loriaut
P
,
Borderie
VM
,
Laroche
L
.
Femtosecond-Assisted Arcuate Keratotomy for the Correction of Postkeratoplasty Astigmatism: Vector Analysis and Accuracy of Laser Incisions
.
Cornea
.
2015
Sep
;
34
(
9
):
1063
6
.
[PubMed]
0277-3740
25.
Kumar
NL
,
Kaiserman
I
,
Shehadeh-Mashor
R
,
Sansanayudh
W
,
Ritenour
R
,
Rootman
DS
.
IntraLase-enabled astigmatic keratotomy for post-keratoplasty astigmatism: on-axis vector analysis
.
Ophthalmology
.
2010
Jun
;
117
(
6
):
1228
1235.e1
.
[PubMed]
0161-6420
26.
Cleary
C
,
Tang
M
,
Ahmed
H
,
Fox
M
,
Huang
D
.
Beveled femtosecond laser astigmatic keratotomy for the treatment of high astigmatism post-penetrating keratoplasty
.
Cornea
.
2013
Jan
;
32
(
1
):
54
62
.
[PubMed]
0277-3740
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.