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Research Article: Femtosecond laser assisted phacoemulsification plus IOL implant: toric IOL vs. astigmatic keratotomy

Date Published: 2026-04-17

Abstract:
To compare the clinical outcomes of femtosecond laser-assisted cataract surgery (FSLACS) with astigmatic keratotomy (AK) versus toric intraocular lens (IOL t ) implantation for astigmatism correction. Retrospective comparative case series. 60 eyes (45 IOL t cases and 15 AK cases) with patient’s mean age of 61.46?±?12.84?years underwent FSLACS with astigmatic correction. Pre and post-operative evaluations included autorefractometry, corneal topography, IOL Master analysis, and assessment of total ocular astigmatism (OA tot ), anterior/posterior/total corneal astigmatism (CA ant /CA post /CA tot ), corneal higher-order aberrations (HOAs), vector analysis, and best-corrected/uncorrected distant visual acuity (BCVA; UDVA; LogMAR). The average follow-up period was 16.29?±?11.15?months. In term of OA tot as demonstrated by polar plots, significant reductions were observed in both the IOL t and the AK groups ( p <?0.001). In regard to CA ant , a statistically significant change was observed in the AK group. No significant change was noted in the IOL t group. In view of CA post , there was no statistically significant difference in CA post for either the IOL t or AK groups, indicating stability of the posterior corneal surface. As for CA tot , the AK group showed a significant pre to post-operative change ( p <?0.001). No significance was found in the IOL t group. Likewise, corneal HOAs remained stable in IOL t but significantly increased in AK ( p <?0.01). This is associated with a significant intergroup difference of p <?0.001. Vector astigmatism analysis utilizing Double Angle Vector Diagrams to show that TIA/SIA/DV/CI for the IOL t group and for the AK group. Vector astigmatism analysis implied that there was no significant difference in target/surgery induced astigmatism (TIA/SIA) between groups. BCVA (LogMAR) improved significantly in both groups [IOL t : 0.40 (0.40, 0.50) to 0.10 (0.00, 0.10); AK: 0.40 (0.40, 0.50) to 0.10 (0.10, 0.15); both p <?0.001]. There is with no significant difference between both groups ( p =?0.49). FSLACS with toric IOL implantation offers an effective and more stable astigmatism correction without increasing HOAs, but also having similar visual outcome improvement, when compared to AK’s astigmatism correction.

Introduction:
In treating corneal astigmatism (CA) less than 1 diopter (D), manual astigmatic keratotomy (AK) is not inferior to toric intraocular lens (IOL t ) implantation. Achieving precision in cut length, depth, and axis alignment is crucial for enhancing reproducibility and minimizing regression ( 1 ). Femtosecond laser-assisted (FSLA) AK (FSLAAK) offers distinct advantages over manual AK, including precise control over incision parameters (length, depth, and axis), increased surgical safety, and reproducible outcomes in…

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