New Combined Technique of Deep Intrastromal Arcuate Keratotomy Overlayed by LASIK Flap for Treatment of High Astigmatism

Purpose: The aim of this study was to describe a novel technique combining deep intrastromal arcuate keratotomy and superficial lamellar keratotomy followed by excimer photoablation for the management of high naturally occurring or postkeratoplasty astigmatism. Methods: In this retrospective case series, the first step was deep intrastromal arcuate keratotomy and superficial lamellar keratotomy performed at 100-mu m depth by femtosecond laser. Manual incisions were made for flap elevation. The second step, after 1 month, consisted of reopening the flap and using an excimer laser to correct residual ametropia. Results: Nine eyes series were studied. The mean preoperative refractive cylinder correction was 6.11 +/- 2.54 diopters (D). The mean postoperative refractive cylinder correction was 2.85 +/- 1.31 D. The mean correction index was 1.07 +/- 0.28 D. The mean best-corrected visual acuity improved from 20/40 to 20/22 after the 2 steps. The median follow-up was 11 (range, 9-17) months. No complications were observed and postoperative outcome was satisfactory. Conclusions: Permitting correction of a broader range of high astigmatism with good accuracy, this combined approach minimizes excision of corneal stromal tissue and postoperative complications.