Femtosecond laser-assisted intrastromal arcuate keratotomy to reduce corneal astigmatism.

PURPOSE: To report the initial results of intrastromal arcuate keratotomy performed with a femtosecond laser to treat corneal astigmatism. SETTING: Department of Ophthalmology, Paracelsus Medical University, Salzburg, Austria. DESIGN: Interventional case series. METHODS: Patients with corneal astigmatism (naturally occurring or after cataract surgery) were treated with an iFS femtosecond laser to perform paired arcuate cuts on the steep axis completely placed within the corneal stroma. Patients were followed for 6 months after surgery. Preoperative and postoperative (1-day, 1-week, and 1-, 3-, and 6-month) examinations included corrected and uncorrected visual acuities, manifest refraction, corneal topography, endothelial cell count, and corneal pachymetry. A subjective questionnaire was used to evaluate patient satisfaction. RESULTS: The study enrolled 16 patients. No perforations occurred, and all incisions were placed at the planned locations. After a 6-month follow-up, the mean refractive cylinder was reduced significantly from 1.41 diopters (D) ± 0.66 (SD) to 0.33 ± 0.42 D (P<.001). The mean topographic astigmatism was reduced significantly from 1.50 ± 0.47 D preoperatively to 0.63 ± 0.34 D at 6 months (P=.002). There was excellent refractive and topographic stability over time. The endothelial cell density was unchanged. Patient satisfaction was very high. CONCLUSION: The femtosecond laser allowed the effective creation of precise, purely intrastromal, arcuate incision patterns with an excellent safety profile, rapid recovery, and stability of vision without the known risks associated with incisions that penetrate Bowman membrane.

One-year visual outcomes and patient satisfaction after surgical correction of presbyopia with an intracorneal inlay of a new design.

PURPOSE: To evaluate the safety and efficacy of the third-generation Kamra corneal inlay (ACI 7000PDT) implanted monocularly in corneal pockets of emmetropic presbyopic patients to improve near and intermediate vision. SETTING: University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. DESIGN: Cohort study. METHODS: The corneal inlay was implanted in the nondominant eye over the line of sight by creating a corneal pocket with a femtosecond laser. The minimum postoperative follow-up was 12 months. Distance, intermediate, and near visual acuities were assessed over the follow-up. Other examinations included slitlamp evaluation, central keratometry, computerized corneal topography, endothelial cell count, and central corneal thickness. Patients completed satisfaction questionnaires preoperatively and 3, 6, and 12 months postoperatively. RESULTS: The study evaluated 24 patients. After a mean follow-up of 12 months, 92% of patients read Jaeger (J) 3 or better with the surgical eye, the mean binocular uncorrected near visual acuity improved from J5 preoperatively to J2, and the mean binocular uncorrected intermediate visual acuity was 20/20 (67% ≥ 20/20). At 12 months, the mean uncorrected distance visual acuity was 20/20 in the surgical eye and 20/16 binocularly. Patients reported no change in distance vision, and their need for reading glasses decreased significantly (P<.001). No inlay was explanted and or recentered during the reported follow-up. CONCLUSION: The new corneal inlay was a safe and effective treatment for presbyopia over a 1-year follow-up.