Five-Year Changes in Corneal Astigmatism After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy

PURPOSE: To investigate the long-term stability of corneal astigmatism after combined femtosecond (fs)-assisted phacoemulsification and arcuate keratotomy. DESIGN: Retrospective, interventional case series. METHODS: Surgery was performed using a Victus (Bausch & Lomb) platform. A single, 450-mu m-deep arcuate keratotomy was paired at the 8-mm zone with the main phacoemulsification incision in the opposite meridian. The keratotomy incisions were not opened. Corneal astigmatism measurements obtained preoperatively and at 2 and 5 years postoperatively were analyzed using vector analysis. RESULTS: A total of 44 eyes of 44 patients (mean age 66.0 +/- 10.1 years) were included. The mean preoperative corneal astigmatism was 1.40 +/- 0.66 diopters (D). This was reduced to 0.74 +/- 0.54 D at 2 years and 0.70 +/- 0.50 at 5 years postoperatively (P < .001). There were no statistically significant differences between postoperative corneal astigmatism at 2 years and at 5 years (P = .609). Both magnitude of error and absolute angle of error were comparable between the 2 postoperative time points (P > .805). At the end of 5 years, 65% of the eyes were within 15 degrees of the preoperative astigmatic meridian. Comparative analysis showed significantly higher surgically induced astigmatism, lower differences in vector and absolute angles of error for the eyes with preoperative with-the-rule (WTR) astigmatism than eyes with against-the-rule (ATR) astigmatism at 5 years (P < .004). CONCLUSIONS: Our study showed the stability of femtosecond (fs)-assisted arcuate keratotomy was well-maintained over 5 years. There was a tendency of increasing overcorrection of preoperative WTR astigmatism and undercorrection of ATR astigmatism over time. ((C) 2020 Elsevier Inc. All rights reserved.)