Femtosecond laser assisted phacoemulsification plus IOL implant: Toric IOL vs astigmatism keratotomy

Aims/Purpose: This study aimed at comparing the clinical outcomes of femtosecond laser‐assisted cataract surgery (FSACS) performing astigmatic keratotomy (AK) and toric intraocular lens (IOLt) implantation for astigmatism correction.Methods: Based on autorefractor and corneal topography, all patients underwent pre‐operative and postoperative examinations including comparatively assessing refractive astigmatism, best corrected visual acuity and corneal high order aberrations.Results: This retrospective case series comprised a total of 20 eyes (IOLt: AK = 10: 10) of 16 patients (mean age: 62.70 ± 1.89 years). Refraction status was 1.98 ± 0.22 in IOLt (0.75~3.00 D) vs 1.95 ± 0.23 in AK (0.55~3.08 D). The follow‐up periods 9.63 ± 1.15 months after surgery.Total corneal astigmatism (CAtot) were 1.73 ± 0.20 D in IOLt/2.28 ± 0.23 D in AK preoperatively and significantly (p < 0.01/p < 0.001) reduced to 0.80 ± 0.17 D in IOLt/1.13 ± 0.07 D in AK. The pre‐operative and postoperative reduction in astigmatism between IOLt (0.93 ± 0.32 D) and AK (1.15 ± 0.21) was not significantly (p = 0.56) different. However, anterior corneal astigmatism (CAant) were 1.99 ± 0.21 D in IOLt/1.95 ± 0.23 in AK preoperatively and not significantly/significantly (p = 0.36/p < 0.05) reduced to 1.73 ± 0.18 D in IOLt/1.10 ± 0.18 D in AK. Regarding CAant, the pre‐operative and postoperative reduction in astigmatism between IOLt (0.36 ± 0.25 D) and AK (0.69 ± 0.21 D) was not significantly (p = 0.3) different.Pre‐FSACS IOLt total corneal HOAs (0.47 ± 0.15) decreased, but not significantly, after FSACS IOLt (0.41 ± 0.11; p = 0.76). However, pre‐FSACS AK total corneal HOAs (0.19 ± 0.02) significantly increased after FSACS AK (0.29 ± 0.03; p < 0.01). Furthermore, the pre‐operative and postoperative changes in total corneal HOAs between IOLt (‐0.06 ± 0.04) and AK (0.10 ± 0.02 D) were significantly (p < 0.01) different.Best corrected visual acuity (Snellen E) was preoperatively 0.42 ± 0.02 in IOLt/0.38 ± 0.02 in AK and significantly (p < 0.001) increased to 0.82 ± 0.06 in IOLt/0.74 ± 0.07 in AK postoperatively. The preoperative and postoperative BCVA alteration was not significant between two groups (IOLt vs AK: 0.40 ± 0.04 vs 0.36 ± 0.07; p = 0.64).Conclusions: IOLt implantation efficient and harmless for correcting preoperative astigmatism in FSACS in a short period.