| Objective: To research the Clinical efficacy of Femtosceond Laser-assisted Corneal Relaxing Incisions(FS-CRIs)on preoperative corneal astigmatism with cataract,and explore the factors related to the efficacy of astigmatism correction.Methods: Retrospective study.Patients with regular corneal astigmatism ≥ 0.75 D who underwent femtosecond laser-assisted cataract surgery(FLACS)in Beijing Aier-Intech Eye Hospital from March 2017 to December 2021 were collected.Femtosecond laser assisted cataract surgery and corneal relaxing incisions were performed on Lensx platform.All patients were divided into three subgroups according to the axis of pre-operative astigmatism,with-the-rule astigmatism group(WTR,90° ±30°)、against-the-rule astigmatism group(ATR,180° ± 30°)and the oblique astigmatism group(OBL,45° ± 15° and 135° ± 15°).Femtosecond laser-assisted cataract surgery and arcuate incisions were performed on Lensx platform.Observe the changes and distribution of corneal astigmatism before and 3 months after surgery in the general and subgroups of WTR and ATR,comparing the astigmatism correction of WTR and ATR astigmatism groups,Pearson correlation coefficient and linear regression analysis are used to evaluate the factors related to Surgically Induced Astigmatism(SIA)in preoperative ocular biometric parameters,and to construct a regression equation.Astigmatism change analysis using Alpins vector analysis method.Results: 94 patients(112 eyes)were included,there were 42 cases(47 eyes)in WTR group,45 cases(56 eyes)in ATR group and 9 cases(9eyes)in OBL group,2 patients have ATR astigmatism in 1 eye and OBL astigmatism in another eye.The corneal horizontal diameter was11.49±0.58 mm and the vertical diameter was 10.66 ± 0.61 mm.Total mean corneal astigmatism before operation was 1.35 ± 0.42 D,and the residual corneal astigmatism was 0.69 ± 0.39 D at 3 months after operation,the net change of astigmatism is 0.67 ± 38 D.In WTR and ATR groups,the net changes of corneal astigmatism were 0.56 ± 0.37D、0.77 ± 0.39 D,respectively.Alpins vector analysis shows that the overall astigmatism Correction Index(CI)is 0.64 ± 0.30,the Flatting Index(FI)is 0.59 ± 0.29,the Index Of Success(IOS)is 0.50 ± 0.24,and the Angle of Error(AE)is-1.53° ± 11.88°.Among these groups,the ATR group has achieved best correction effect(CI is 0.80 ± 0.26,FI is 0.74 ± 0.26,IOS is 0.40 ± 0.23),the WTR group takes the second place(CI is 0.42 ± 0.21,FI is 0.40 ± 0.20,IOS is 0.62 ± 0.21).Pearson correlation coefficient shows patient’s age(r = 0.190,P < 0.05),preoperative corneal astigmatism(r = 0.427,P< 0.001),arc length of relaxing incisions(r =0.335,P<0.001)and distance between relaxing incisions and limbus(r =0.241,P<0.05)are significantly correlated with SIA.Simple linear regression analysis shows that the type of astigmatism is also an important predictor of SIA(P< 0.05).The regression equation of SIA is constructed by multiple linear regression analysis,SIA =-0.898 + 0.010× Patient’s age + 0.020 × arc length of relaxing incisions + 0.152 ×distance between relaxing incisions and limbus(F = 12.846,P<0.001),R2 = 0.263.Conclusions: Femtosceond laser-assisted corneal relaxing incisions is effective and safe in the treatment of corneal astigmatism before cataract surgery,the same relaxing incisions’ design achieved better curative effect in against-the-rule astigmatism group,and the distance between relaxing incisions and limbus maybe an important factor affecting SIA. |
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