1. Laser in situ keratomileusis for correction of residual astigmatism after cataract surgery
Eun Chul Kim, M.D. , Man Soo Kim,M.D.
Department of Ophthalmology and Visual Science,
College of Medicine,
The Catholic University of Korea, Seoul, Korea
No financial relationship

2. Introduction high amount of corneal astigmatism after cataract surgery
delays visual recovery
compromises the ultimate optical outcome.
Spectacle correction
distortion due to meridional magnification,
difficulties with binocular function.
Contact lenses
:not all patients can tolerate contact lenses

3. Introduction : To reduce corneal astigmatism
Intraoperative method
variation in size, location, and type of incision
adjust suture depth
preplaced sutures to facilitate wound closure
use of surgical keratometers
suture adjustment technique
selective suture cutting
Postoperative method
Wound revision
Corneal wedge resection
Tensioning suture
Astigmatic keratotomy
Transverse keratotomy
Photorefractive keratectomy (PRK)
Laser in situ keratomileusis(LASIK)

4. Purpose
To evaluated the effect of laser assisted in situ keratomileusis (LASIK) procedure on eyes with residual astigmatism after cataract surgery.

5. Methods
Retrospectively reviewed the medical records of 11 eyes of 11 patients who had undergone cataract surgery from March 2002 to November 2005.
Cataract Operation
: 10 eyes: Phacoemulsification + PCL implanatation
: 1 eye: Extracapsular cataract extraction + PCL transscleral fixation+ ant. vitrectomy
LASIK (11 eyes) was performed on 11 eyes
The ablation zone 6.0 mm
the transition zone 8.0 mm
minimum of 250 μm of the stromal bed was maintained

6. Methods Inclusion criteria of astigmatic correction
refractive myopic or mixed astigmatism over 2.0D
Stable refraction (change less than 0.50 D between two consecutive examinations)
symptomatic anisometropia,
Inability to wear spectacles
Contact lens intolerance
no history of systemic collagen vascular disease
no history of ocular disease(e.g. glaucoma, retinopathy)
central corneal thickness greater than 500 μm

7. Results : Refraction and visual acuity
Before eximer laser surgery
6 Months After eximer laser surgery NO
Age
/Sex
Procedure
*UCVA
Manifest Refraction
†BCVA
UCVA
BCVA 1
86/M
LASIK
0.1
x 180˚
0.4
0.63
x 180˚
0.8 2
59/F
0.25
x 150˚
1.0
x 150˚ 3
66/M
0.2
x 85˚
x 90˚ 4
52/F
x 175˚
x 170˚ 5
78/F
x 180˚
0.32
x 180˚ 6
60/M
0.5
x 25˚
x 30˚ 7
67/M
0.3
x 155˚
x 155˚ 8
68/M
x 175˚
-0.50 sphere 9
20/M
0.08
x 165˚
x 165˚ 10
72/F
x 95˚
x 90˚ 11
57/M
x 30˚
x 30˚
*: UCVA = uncorrected visual acuity, †BCVA = best corrected visual acuity
At 6 months after refactive surgery, best corrected visual acuity was equal to or better than preoperatively

8. Spherical equivalent refraction and cylinderical refraction
Spherical equivalent and cylinderical refraction decreased significantly after LASIK.
( * = p <0.05)

9. Postoperative visual acuity
UCVA and BCVA were improved at 2 weeks after surgery and were stable until 6 months after surgery.
(* = p<0.05)
The final BCVA was improved by 1 line in 4 eyes (36.4%) and was unchanged in 7 eyes (63.6%) at 6 months.

10. Reduction of Astigmatism(%)
Change of astigmatism NO
Preoperative
Astigmatism (D)
Postoperative
Net Decrease
in Astigmatism (D)
Reduction of Astigmatism(%) 1
-5.5 x 180˚
-1.25 x 180˚
4.25
77.27 2
-3.5 x 150˚
-0.25 x 150˚
3.25
92.86 3
-2.00 x 85˚
-0.75 x 90˚
1.25
62.50 4
-3.00 x 175˚
-0.75 x 170˚
2.25
75.00 5
-4.50 x 180˚
-1.00 x 180˚
3.5
77.78 6
-2.50 x 25˚
-0.50 x 30˚
80.00 7
-3.50 x 155˚
-1.25 x 155˚
64.29 8
-2.50 x 175˚
2.5
100.00 9
-5.75 x 165˚
-1.50 x 165˚
73.91 10
-3.25 x 95˚
-1.00 x 90˚
69.23 11
-2.75 x 30˚
81.82
Mean±SD
-3.52±1.17
-0.80±0.44
2.73±0.96
77.70±11.20
The mean percentage of astigmatic correction was 77.70±11.20% (range to 100%) at 6 months after refactive surgery

11. Predictablility for refraction and astigmatism
Follow up
±0.25 D
± 0.50 D
± 0.75 D
± 1.00 D
* SE
† C SE C
2weeks
4(36.4)
7(63.6)
9(81.8)
10(90.9)
11(100)
1month
3(27.3)
6(54.5)
8(72.7)
2months
1(9.1%)
5(45.4)
6months
2(18.2)
*: SE= spherical equivalent refraction, † : Cylinder refraction
After 6 months after surgery,
4 eyes (36.4%) had a spherical equivalent refraction within ± 0.50 D, and 9 eyes (81.8%) were within ±1.00 D.
Four eyes (36.4%) had a cylinder refraction within ± 0.50 D
and 8 eyes (72.7%) were within ±1.00D.

12. Conclusion
LASIK
an effective, predictable, stable procedure for correction of residual myopic or mixed astigmatism over 2.0 D with a low spherical component after cataract surgery.