Refractive outcomes of femtosecond laser-assisted secondary arcuate incisions in patients with residual refractive astigmatism after trifocal intraocular lens implantations

Purpose: To evaluate the refractive and visual outcomes of arcuate incisions performed with the femtosecond laser in patients with a residual refractive astigmatism after refractive lens exchange (RLE) with trifocal intraocular lenses (IOLs). Setting: EuroEyes Clinical Group, Hamburg, Germany. Design: Retrospective interventional case series. Methods: Pseudophakic patients with remaining refractive astigmatism after RLE with a trifocal IOL were treated with femtosecond laser-assisted corneal arcuate incisions. Patients who had a previous corneal treatment were excluded. Outcome measures were uncorrected (UDVA) and corrected distance visual acuities, manifest refraction, and a power vector analysis. Results: The study enrolled 95 eyes of 70 patients. The mean follow-up was 5.6 months +/- 4.9 (SD). Constructing an astigmatic power vector (APV) with Jackson cross-cylinder axes at 180 degrees and 90 degrees and Jackson cross-cylinder axes at 45 degrees and 135 degrees, the mean preoperative vector length was 0.46 +/- 0.16 diopter (D). The mean postoperative APV was 0.17 +/- 0.16 D. This difference was statistically significant (P < .001). The difference between the UDVA preoperatively (0.17 +/- 0.15) and postoperatively (0.08 +/- 0.10) was statistically significant (P < .001). No intraoperative or postoperative complications were observed. Conclusion: Femtosecond laser-assisted corneal arcuate incisions were safe, efficient, and feasible to reduce refractive astigmatism after trifocal IOL implantation. (C) 2018 ASCRS and ESCRS