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    Aspiring for zero tolerance of residual astigmatism

    Case examples highlight tools, techniques toward quest for excellent visual endpoint

     

    Figure 2 shows a femtosecond laser limbal, arcuate keratotomy that was performed to correct astigmatism. A similar technique can be used even at the slit lamp or intraoperatively using specially designed diamond blades.

    The advantage of the femtosecond laser over diamond blade could be when used simultaneously for cataract surgery, especially in cases of anterior basement membrane dystrophy where there is no distortion of the weak epithelium, precision-wise as long as parameters of personal “fudge factors” are followed results could be equally satisfying.

    Figure 3 explores how the confidence of correcting astigmatism with the excimer laser also can help surgeons to correct patients who have undergone a previous refractive surgery, such as lens-based multifocal IOL implantation during cataract surgery in an eye with RK. Laser advanced surface ablation (ASA) in Corneoplastique mode was performed as a staged procedure to correct astigmatism to bring the patient to emmetropia even in complex cases that had undergone multifocal IOL implantation with a previous RK.

    Arun C. Gulani, MD
    Dr. Gulani is director of refractive surgery and chief, cornea & external disease, as well as assistant professor, department of ...

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