Long-Term Stability of Dual-Pulse Femtosecond Laser Arcuate Incisions for Astigmatism
Overview
A study of 20 eyes followed for 24 to 36 months demonstrated that femtosecond laser-created beveled arcuate incisions provide stable astigmatism correction with maintained visual acuity. Over 90% of eyes achieved surgically induced astigmatism within 0.5 D of the target, and uncorrected distance visual acuity remained excellent through 3 years.
Background
Astigmatism correction during refractive cataract surgery can be achieved using laser arcuate incisions. The dual-pulse femtosecond laser technique creates beveled incisions designed to enhance corneal biomechanical stability and reduce regression. Long-term data on the stability and efficacy of these laser arcuate keratotomies are limited but critical for validating their clinical utility. This study aimed to assess the durability of astigmatism correction and visual outcomes up to 36 months postoperatively.
Data Highlights
| Parameter | Preoperative | 4-6 Weeks Postop | 24-36 Months Postop |
|---|---|---|---|
| Mean Keratometric Astigmatism (D) | 0.62 ± 0.37 | 0.32 ± 0.27 | Maintained at 0.32 ± 0.27 |
| Percentage with Surgically Induced Astigmatism ≤0.5 D of Target | >90% | ||
| Mean Uncorrected Distance Visual Acuity (logMAR) | N/A | 0.09 ± 0.11 | 0.08 ± 0.09 |
| Percentage Achieving UDVA 20/30 or Better | 95.5% | ||
Key Findings
- Preoperative astigmatism averaged 0.62 ± 0.37 D and was significantly reduced to 0.32 ± 0.27 D at 4-6 weeks postoperatively.
- The reduction in astigmatism was maintained through 24 to 36 months follow-up.
- More than 90% of eyes achieved surgically induced astigmatism within 0.5 D of the intended correction.
- Mean uncorrected distance visual acuity remained stable from 4-6 weeks (0.09 ± 0.11 logMAR) to 24-36 months (0.08 ± 0.09 logMAR).
- 95.5% of eyes achieved postoperative UDVA of 20/30 or better at long-term follow-up.
- The beveled design of the incisions contributed to corneal biomechanical stability, minimizing regression or wound gaping.
Clinical Implications
Femtosecond laser-created beveled arcuate incisions offer a precise and durable method for correcting low-to-moderate astigmatism in refractive cataract surgery. This technique is especially valuable when toric intraocular lenses are not suitable or available. The long-term stability supports its use for fine-tuning refractive outcomes with minimal risk of regression.
Conclusion
The study validates the long-term efficacy and stability of dual-pulse femtosecond laser arcuate incisions for astigmatism correction, supporting their role as a reliable option in refractive cataract surgery. These findings provide important evidence for sustained visual and refractive benefits through 36 months.
References
- Visco D, 2025 ASCRS Annual Meeting -- Long-Term Stability of Incisions With Dual-Pulse Femtosecond Laser for Astigmatism
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