Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram

Carter W Lim,1– 3 Sohel Somani,3– 5 Hannah H Chiu,3– 5 Raj Maini,3– 5 Eric S Tam3– 5 1Faculty of Medicine, University of Ottawa, Ottawa K1H 8M5, Canada; 2Eye Foundation of Canada, Toronto M3N 2V6, Canada; 3William Osler Health System, Brampton L6R 3J...

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Autores principales:	Lim CW, Somani S, Chiu HH, Maini R, Tam ES
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	astigmatism astigmatic keratotomy refractive laser-assisted cataract surgery Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/44545a7a24a240bcb5257f9e5ce4a71a
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spelling	oai:doaj.org-article:44545a7a24a240bcb5257f9e5ce4a71a2021-12-02T08:36:30ZAstigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram1177-5483https://doaj.org/article/44545a7a24a240bcb5257f9e5ce4a71a2020-04-01T00:00:00Zhttps://www.dovepress.com/astigmatic-outcomes-of-single-non-paired-intrastromal-limbal-relaxing--peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Carter W Lim,1– 3 Sohel Somani,3– 5 Hannah H Chiu,3– 5 Raj Maini,3– 5 Eric S Tam3– 5 1Faculty of Medicine, University of Ottawa, Ottawa K1H 8M5, Canada; 2Eye Foundation of Canada, Toronto M3N 2V6, Canada; 3William Osler Health System, Brampton L6R 3J7, Canada; 4Uptown Eye Specialists, Brampton L6Y 0P6, Canada; 5Faculty of Medicine, University of Toronto, Toronto M5S 1A8, CanadaCorrespondence: Eric S TamUptown Eye Specialists, 401-7900 Hurontario Street, Brampton L6Y 0P6, ON, CanadaTel +1416-292-0330Email ericstam@gmail.comPurpose: To determine astigmatic changes of intrastromal limbal-relaxing incisions (LRIs) performed during femtosecond laser-assisted cataract surgery (FLACS).Design: Retrospective case series.Patients and Methods: Patients undergoing FLACS with adjunctive astigmatism management with intrastromal LRIs were included. All eyes had preoperative corneal cylinder (Kcyl) ≥ 0.20 D on ocular biometry. An intrastromal LRI nomogram of single, non-paired LRIs placed at the 9 mm optical zone was used. Keratometry was measured preoperatively, and postoperatively at 1 week, 1 month, and 3 months (POM3). Alpins astigmatism analysis was used to calculate target-induced astigmatism (TIA, equivalent to preoperative Kcyl), surgically induced astigmatism (SIA), difference vectors (DV), and correction indices (CI). Secondary analysis included multivariable binary logistic regression to determine clinical factors associated with corrections > 125% (CI >  1.25).Results: A total of  154 eyes (125 patients) were studied. Mean preoperative Kcyl was 0.87± 0.42 D (SD), which did not significantly differ from POM3 Kcyl (0.87± 0.51 D, p=0.470). Only the against-the-rule (ATR) subgroup demonstrated a small but significant reduction in Kcyl from preoperative (0.96± 0.51D) to POM3 (0.89± 0.55D, p=0.032). Sixteen eyes (10.4%) had Kcyl ≤ 0.5 D preoperatively, compared to 46 eyes (29.9%) at POM3 (p< 0.0001). Mean SIA was 0.80± 0.52 D. Mean DV was 0.85± 0.47. Mean CI was 0.79. Fifty-one eyes (33%) had astigmatism correction > 125%. On multivariable regression analysis, ATR astigmatism class (p=0.026) and lower arc lengths (30º) (p=0.005) were associated with correction > 125%. Lower preoperative corneal astigmatism was inversely correlated with CI (p< 0.001).Conclusion: Although intrastromal LRIs can be conveniently performed during FLACS and appear safe, only patients with ATR astigmatism demonstrated a significant reduction in corneal astigmatism 3-months postoperatively under the current nomogram. Areas for future refinements to the nomogram were identified.Keywords: astigmatism, astigmatic keratotomy, refractive laser-assisted cataract surgeryLim CWSomani SChiu HHMaini RTam ESDove Medical Pressarticleastigmatismastigmatic keratotomyrefractive laser-assisted cataract surgeryOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 1059-1070 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	astigmatism astigmatic keratotomy refractive laser-assisted cataract surgery Ophthalmology RE1-994
spellingShingle	astigmatism astigmatic keratotomy refractive laser-assisted cataract surgery Ophthalmology RE1-994 Lim CW Somani S Chiu HH Maini R Tam ES Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram
description	Carter W Lim,1– 3 Sohel Somani,3– 5 Hannah H Chiu,3– 5 Raj Maini,3– 5 Eric S Tam3– 5 1Faculty of Medicine, University of Ottawa, Ottawa K1H 8M5, Canada; 2Eye Foundation of Canada, Toronto M3N 2V6, Canada; 3William Osler Health System, Brampton L6R 3J7, Canada; 4Uptown Eye Specialists, Brampton L6Y 0P6, Canada; 5Faculty of Medicine, University of Toronto, Toronto M5S 1A8, CanadaCorrespondence: Eric S TamUptown Eye Specialists, 401-7900 Hurontario Street, Brampton L6Y 0P6, ON, CanadaTel +1416-292-0330Email ericstam@gmail.comPurpose: To determine astigmatic changes of intrastromal limbal-relaxing incisions (LRIs) performed during femtosecond laser-assisted cataract surgery (FLACS).Design: Retrospective case series.Patients and Methods: Patients undergoing FLACS with adjunctive astigmatism management with intrastromal LRIs were included. All eyes had preoperative corneal cylinder (Kcyl) ≥ 0.20 D on ocular biometry. An intrastromal LRI nomogram of single, non-paired LRIs placed at the 9 mm optical zone was used. Keratometry was measured preoperatively, and postoperatively at 1 week, 1 month, and 3 months (POM3). Alpins astigmatism analysis was used to calculate target-induced astigmatism (TIA, equivalent to preoperative Kcyl), surgically induced astigmatism (SIA), difference vectors (DV), and correction indices (CI). Secondary analysis included multivariable binary logistic regression to determine clinical factors associated with corrections > 125% (CI >  1.25).Results: A total of  154 eyes (125 patients) were studied. Mean preoperative Kcyl was 0.87± 0.42 D (SD), which did not significantly differ from POM3 Kcyl (0.87± 0.51 D, p=0.470). Only the against-the-rule (ATR) subgroup demonstrated a small but significant reduction in Kcyl from preoperative (0.96± 0.51D) to POM3 (0.89± 0.55D, p=0.032). Sixteen eyes (10.4%) had Kcyl ≤ 0.5 D preoperatively, compared to 46 eyes (29.9%) at POM3 (p< 0.0001). Mean SIA was 0.80± 0.52 D. Mean DV was 0.85± 0.47. Mean CI was 0.79. Fifty-one eyes (33%) had astigmatism correction > 125%. On multivariable regression analysis, ATR astigmatism class (p=0.026) and lower arc lengths (30º) (p=0.005) were associated with correction > 125%. Lower preoperative corneal astigmatism was inversely correlated with CI (p< 0.001).Conclusion: Although intrastromal LRIs can be conveniently performed during FLACS and appear safe, only patients with ATR astigmatism demonstrated a significant reduction in corneal astigmatism 3-months postoperatively under the current nomogram. Areas for future refinements to the nomogram were identified.Keywords: astigmatism, astigmatic keratotomy, refractive laser-assisted cataract surgery
format	article
author	Lim CW Somani S Chiu HH Maini R Tam ES
author_facet	Lim CW Somani S Chiu HH Maini R Tam ES
author_sort	Lim CW
title	Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram
title_short	Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram
title_full	Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram
title_fullStr	Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram
title_full_unstemmed	Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram
title_sort	astigmatic outcomes of single, non-paired intrastromal limbal relaxing incisions during femtosecond laser-assisted cataract surgery based on a custom nomogram
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/44545a7a24a240bcb5257f9e5ce4a71a
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Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram

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