Symmetrical femtosecond laser arc incision in correcting corneal astigmatism in cataract patients

AIM:To evaluate the effect of symmetrical arc incision correcting corneal astigmatism in femtosecond laserassisted phacoemulsification(FLACS).METHODS:This study enrolled patients with cataract combined with regular corneal astigmatism of>0.75 D,who underwent FLACS.Symmetrical arc incision was set at 8 mm diameter and 85%depth.The follow-up time was 3-24mo(4.92±3.49mo).Pentacam recorded the corneal astigmatism and higher-order aberration at pre-operation and post-operation.The changes in corneal astigmatism were analyzed by Alpins method.The correlation of astigmatism type,age,corneal horizontal diameter,corneal thickness,arc incision length,and correction index(CI)was analyzed,and the residual corneal astigmatism was compared with the residual whole eye astigmatism.RESULTS:Totally 79 patients(102 eyes)were enrolled,10 patients had corneal epithelial injury,1 patient occurred corneal epithelial hyperplasia.The corneal astigmatism was 1.23±0.38 D pre-operation,and decreased to 0.76±0.39 D post-operation(t=10.146,P=0.000).Corneal high-order aberration was 0.17±0.08μm pre-operation and 0.24±0.11μm post-operation(t=-5.186,P=0.000).The residual corneal astigmatism and residual whole eye astigmatism were no significant difference(t=-0.347,P=0.729).Using Alpin’s method,the following were determined:target-induced astigmatism(TIA)=1.23±0.38 D,surgeryinduced astigmatism(SIA)=0.77±0.45 D,difference vector(DV)=0.77±0.39 D,and CI=0.54±0.28.Age,astigmatism size,corneal horizontal diameter,corneal thickness,and arc incision length were not correlated with CI.The CI for against the rule astigmatism(ATR)was better than that for with the rule astigmatism(WTR;P=0.001).CONCLUSION:Femtosecond laser-assisted astigmatic keratotomy has better CI of ATR,but increase higher-order corneal aberration.CI is not ideal,it’s not a perfect choice if we pursue ideal correction effect.

Analysis of independent risk factors for acute acquired comitant esotropia

comitant esotropia(AACE).METHODS:A retrospective cohort study was conducted by analyzing 83 patients(case group)with AACE who underwent strabismus correction surgery from January 1,2021 to June 30,2022.Totally 73 outpatient volunteers were recruited during the same period as the normal control group.The case group’s binocular vision time,near and distance esotropia angle,and near stereo vision function were recorded,and the age,gender,refractive status,and best-corrected visual acuity(BCVA)of both groups were analyzed.Additionally,multiple logistic regression analysis was conducted using an eye usage condition questionnaire to determine the independent risk factors for AACE.RESULTS:In the case group,61 patients(73.49%)had myopia,with a mean equivalent spherical power(SE)of-3.35±3.31 D(range:+2.75 to-10.62 D)of the right eye and-2.87±3.35 D(range:+2.75 to-11.12 D)of the left eye.The average duration of diplopia in the case group was 29.83±35.72mo,of which 80 patients(96.39%)were primarily with distance diplopia.The near and distance esotropia angle after wearing glasses were 52.36±20.95 prism degree(PD)and 56.71±19.54 PD,respectively,and there was no statistically significant difference between the two(t=1.38,P=0.169).The incidence of improper glasses wearing and unhealthy eye habits in the case group was significantly higher than those in the control group(P<0.05).Close-up work without glasses[β=2.30,odds ratio(OR)=10,95%confidence interval(CI)2.35-42.51,P=0.002]and near work in supine position(β=1.80,OR=6.02,95%CI 3.29-11.02,P<0.001)were independent risk factors for AACE.CONCLUSION:Patients with AACE mainly present with distance diplopia,and there is a high degree of variation in myopia.Near work without wearing glasses and in supine position are independent risk factors for AACE.