Lamellar keratotomy to correct astigmatism in cataract surgery

Background For the correction of astigmatism in cataract surgery, several incisional procedures have been developed. In this study, a modification of lamellar keratotomy was evaluated to correct astigmatism in cataract surgery.Methods Prospectively 32 eyes of 25 patients with a preoperative astigmatism greater than 1.5 D were studied. All patients were treated with lamellar keratotomy with an incision width of 6 mm and a radial length of 1.5 mm placed at the limbus in the steep meridian. Phacoemulsification and IOL implantation were then performed through a 3.2-mm corneal tunnel incision. After 4 weeks, mean astigmatism, mean corneal power changes, and mean surgically-induced astigmatism derived from vector analysis in the central 3-mm optical zone were determined.Results The mean astigmatism decreased from 2.75±0.80 D preoperatively to 1.58±0.91 D after 4 weeks (P<0.001). There were no significant changes (P=0.614) of the mean corneal power. The mean surgically-induced astigmatism was 2.59±1.50 D. The induced changes were more accentuated in superior incisions. In corneal topography, 78% of the treated eyes revealed a characteristic threefold pattern of the mid-peripheral cornea postoperatively, which impaired the corneal optical performance in ray-tracing analysis.Conclusions Lamellar keratotomy effectively reduced high preoperative astigmatism in cataract surgery. This surgical approach was combined with a superior, temporal, or oblique corneal incision.Presented in part at the Annual Meeting of the Deutsche Ophthalmologische Gesellschaft in Berlin, September 2003.