Arcuate keratotomy to treat corneal astigmatism after cataract surgery: A prospective evaluation of predictability and effectiveness

Abstract Objective Although several nomograms are available for the incisional keratotomy to correct naturally occurring astigmatism, astigmatic keratotomy in eyes after cataract surgery has not been well analyzed. The predictability and effectiveness of arcuate keratotomy in pseudophakic eyes were studied. Design A prospective, multicenter study. Participants One hundred four eyes of 86 patients with residual corneal astigmatism of 1.5 diopters (D) or more after cataract surgery were examined. Intervention Arcuate keratotomy was performed in nine centers by nine surgeons. Main outcome measures The amount of astigmatic correction was calculated using the vector analysis of preoperative and 6-month postoperative refractive cylinder results. Results Multiple regression analysis showed that optical zone size, number of incisions, and incision length had significant correlations with the amount of astigmatic correction. The regression equation was expressed as effects=(−0.643 × optical zone size) + (0.998 × incision number) + (0.057 × incision length) + 2.356. The parameter of predictability ( r 2 : 35%) was lower than that reported for congenital astigmatism (48 ∼ 56%). A new nomogram was derived based on the multiple regression equation. Conclusions Astigmatic keratotomy in pseudophakic eyes is less predictable than that in eyes with idiopathic astigmatism, but the procedure is sufficiently effective in reducing the residual astigmatism after cataract surgery. Individual nomograms are necessary for astigmatic keratotomy in eyes with naturally occurring and postsurgical astigmatism.