A prospective study investigating the long-term stability of changes in astigmatism following arcuate lamellar keratotomy (ALK): 3-year results

Introduction: The correction of low to moderate astigmatism is possible tod ay by means of photoablation (PRK), while the treatment of moderate and hig her astigmatism still involves refractive keratotomy. Experience has shown that cataract surgery, using modern tunnel techniques with self-healing inc isions, results in earlier stability in both the refractive outcome and wou nd healing. In this study, we attempted to combine the advantages of lamell ar keratotomy with those of a pair-wise T-incision as arcuate lamellar kera totomy (ALK). Patients and methods: The clinical outcome of 41 patients who underwent ALK was investigate in a prospective study over a period of 3 years. The pre- and postoperative investigations undertaken included the measurement of ast igmatism using a Zeiss keratometer, uncorrected visual acuity, and correcte d glare vision using a Humphrey autorefractor. All patients had astigmatism between 2.0 and 7.0 D. Together with a uniform arcuate incision, we used 7 mm (n = 26) and 8 mm (n = 15) mm zones for correction. Results: The average preoperative astigmatism was 4.01 +/- 1.90 (median, 3. 50) D. After a 3-year follow-up the average postoperative astigmatism was 1 .59 +/- 1.29 (median, 1.38) D. The astigmatic change induced (Jaffe) after 3 years was about 3.23 +/- 2.23 (median, 3.16) D. The average uncorrected v isual acuity (log MAR) before ALK was 0.20 +/- 0.12 (median, 0.22) and afte r followup, 0.41 +/- 0.14 (median, 0.39). Corrected glare vision before sur gery was 0.23 +/- 0.19 (median, 0.10) and afterwards, 0.25 +/- 0.22 (median , 0.14). Conclusions: Arcuate lamellar keratomy (ALK) stood the test as a routine cl inical procedure for correction of moderate astigmatism with stable postope rative functional outcomes. We did not find impairment of glare vision foll owing this procedure.