A new concept for the correction of astigmatism: full-arc, depth-dependent astigmatic keratotomy.

摘要

OBJECTIVE: The purpose of this study is to introduce and evaluate a new concept in astigmatic keratotomy (AK) named full-arc, depth-dependent AK (FDAK). DESIGN: Noncomparative interventional case series. PARTICIPANTS: FDAK was performed on a total of 37 eyes with regular astigmatism; of these, 16 eyes received FDAK alone, and 21 eyes received FDAK combined with cataract surgery. METHODS: Corneal topography was used to divide the cornea into two discreet regions of "steep" and "flat." Then, paired arcuate incisions, 90 degrees in length, were placed along the full arc of the steep area. The level of astigmatic correction was controlled by varying the incision depth from 40% to 80% on the basis of a provisional nomogram developed by the authors. MAIN OUTCOME MEASURES: Keratometries, corneal topographies, and visual acuities were measured. RESULTS: The FDAK alone group showed a significant improvement from a preoperative corneal astigmatism of 2.90 +/- 0.78 diopters (D) to a postoperative value of 0.89 +/- 0.52 D. The "combined" group also showed significant improvement from a preoperative corneal astigmatism of 2.97 +/- 1.01 D, to a postoperative value of 1.02 +/- 0.45 D. The deviation of achieved correction from attempted correction using vector analysis was between 1.37 D of undercorrection and 0.98 D of overcorrection, with 91.9% of cases within the range of +/- 1.0 D. Slight oblique change caused by axis deviation was observed in seven cases. Both uncorrected and corrected visual acuity showed statistically significant improvement. No serious complications were encountered. CONCLUSIONS: Controlling the level of correction by varying the incision depth allowed the surgeon to use long incisions (90 degrees in length in regular astigmatism) covering the entire steep area, minimizing the undesirable changes induced by conventional deep and narrow incision AK and resulting in an ideal corneal sphericity after surgery. FDAK enabled the surgeon to accurately control the level of astigmatic correction with minimal risk of corneal perforation.