Arcuate Keratotomy after Phacoemulsification for Correction of Astigmatism

1. Robert Blum
2. James Cameron
3. Shyamanga Borooah
4. Roly Megaw
5. Ashraf Khan
6. Ashish Agrawal

Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom

Purpose
To report the results of arcuate keratotomy at the time of phacoemulsification in patients with high degrees of astigmatism.

Methods
Seven eyes of 7 patients had arcuate keratotomy performed at the time of cataract surgery. Phacoemulsification was performed followed by arcuate keratotomy. Patients with astigmatism greater than 3D were included. All patients were examined preoperatively and postoperatively. The following data were collected: refraction, best spectacle-corrected (BSCVA) and uncorrected (UCVA) visual acuities. Surgery was performed under local anesthesia. Preoperative corneal topography, biometry, ultrasound pachymetry were performed to guide the number, extent and depth of the corneal incisions.

Results
The mean preoperative astigmatism was 5.40 +/- 1.09 diopters (D) (range 3.5 to 6.75 D) compared to postoperative astigmatism of 1.90 +/- 1.20 D (range 0.75 to 4 D). The average reduction in astigmatism was 3.42 +/- 1.38 D (range 2.0 to 5.5 D). BSCVA improved from an average of 6/10 (range 6/7.5 to 6/24) preoperatively to 6/7 (range 6/4 to 6/10) postoperatively.

Conclusions
Arcuate keratotomy combined with phacoemulsification and monofocal intraocular lens implantation is a safe, effective and predictable means of correcting large astigmatic errors at the time of cataract surgery. It is a useful alternative for the correction of astigmatism at the time of cataract surgery when access to toric intraocular lenses is limited.