J Korean Ophthalmol Soc.  2015 Aug;56(8):1160-1169. 10.3341/jkos.2015.56.8.1160.

Clinical Outcomes of Beveled, Full Thickness Astigmatic Keratotomy

• Kim BK
• Mun SJ
• Lee DG
• Chung YT

• KMID: 2215066
• DOI: http://doi.org/10.3341/jkos.2015.56.8.1160

Abstract

PURPOSE
To evaluate the beveled, full thickness astigmatic keratotomy.
METHODS
This study included 185 eyes of 112 patients treated with beveled, full thickness astigmatic keratotomy. Treated eyes were divided into 3 groups: beveled, full thickness astigmatic keratotomy after implantable collamer lens (ICL) implantation (group A), beveled, full thickness astigmatic keratotomy after cataract surgery (group B) and beveled, full thickness astigmatic keratotomy alone (group C). Follow-up visits were at 1 week, 1 month, 3 months and 6 months. The outcome measures included uncorrected distance visual acuity, astigmatism, efficacy, safety and predictability.
RESULTS
At 6 months postoperatively, astigmatism was significantly reduced: 68.9 +/- 18.24% in total, 69.24 +/- 20.76%, in the group A, 67.84 +/- 17.56% in the group B and 67.82 +/- 13.97% in the group C. The proportion of eyes with astigmatism 1.0 or less was 88.65% in total, 91.49% in the group A, 87.5% in the group B and 70.0% in the group C. Mean improvement in corrected distance visual acuity (CDVA) was 0.56 lines; no eyes lost 2 lines of CDVA after 6 months postoperatively. Postoperative complications were not observed.
CONCLUSIONS
This study showed the beveled, full thickness astigmatic keratotomy is effective and safe for correcting astigmatism alone as well as correcting astigmatism after ICL implantation or cataract surgery.

Keyword

Astigmatic keratotomy; Astigmatism; High astigmatism

MeSH Terms

Astigmatism
Cataract
Follow-Up Studies
Humans
Outcome Assessment (Health Care)
Postoperative Complications
Visual Acuity

Figure

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  Figure 1. (A) Corneal marking with a ring marker with cross wires (7.5 mm). (B) Making at 3, 9, 12 o’clock direction with marking pen. (C) Beveled, full thickness cornea incision with 2.8 mm blade. (D) Extension of corneal incision with wider blade. (E) Checking the wound with a Weck-Cel sponge if there is any leakage. (F) Subconjunctival injection with mixture of antibiotics, ste-roid, and lidocaine.

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  Figure 2. Changes in cylinder after the beveled, full thickness astigmatic keratotomy. Preop = Preoperation.

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  Figure 3. (A) Preoperative astigmatism. (B) Postoperative astigmatism at 6 months.

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  Figure 4. Predictability. Bar graph represents the percentage of eyes within 0.5D and 1.0D of intended correction at 6 months postoperatively. D = diopters.

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  Figure 5. Change in astigmatism from preoperatively. D = diopters.

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  Figure 6. Safety. Gain and loss of CDVA 6 months postoperatively. CDVA = corrected distance visual acuity.

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  Figure 7. Case example. Beveled full thickness astigmatic keratotomy was performed on the left eye at 12:30 o’clock direction, 5.7-mm width in a patient after ICL implantation. (A) The incision is faintly seen on slit-lamp photography at 1 month post-operatively (dotted line). (B) Kmax was 44.6 D at steep axis on preoperative topography. UCVA was 20/30, CDVA was 20/20, re-fraction was +1.5 -2.75 × 165° preoperatively. (C) At the 1 month postoperative visit, UCVA and CDVA were 20/16, refraction was +0.25 -0.25 × 170°. Kmax was 42.5 D at steep axis. (D) Anterior OCT image of the incision site for ICL implantation. Perpendicular incision can be seen. (E) Anterior OCT image of the incision site for astigmatic keratotomy. Beveled, full thickness incision can be seen. ICL = implantable collamer lens; K = keratometry; UCVA = uncorrected visual acuity; CDVA = corrected distance visual acuity; OCT = optical coherence tomography.

Reference

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