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

Purpose 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. Design Retrospective comparative case series. Methods 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. Results 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). Conclusion 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.