title: New combined technique of deep intrastromal arcuate keratotomy overlayed by LASIK flap for treatment of high astigmatism.
abstract: OBJECTIVE
  The aim of this study was to describe a novel technique combining deep intrastromal arcuate keratotomy and superficial lamellar keratotomy followed by excimer photoablation for the management of high naturally occurring or postkeratoplasty astigmatism.
  
  
  METHODS
  In this retrospective case series, the first step was deep intrastromal arcuate keratotomy and superficial lamellar keratotomy performed at 100-μm depth by femtosecond laser. Manual incisions were made for flap elevation. The second step, after 1 month, consisted of reopening the flap and using an excimer laser to correct residual ametropia.
  
  
  RESULTS
  Nine eyes series were studied. The mean preoperative refractive cylinder correction was 6.11 ± 2.54 diopters (D). The mean postoperative refractive cylinder correction was 2.85 ± 1.31 D. The mean correction index was 1.07 ± 0.28 D. The mean best-corrected visual acuity improved from 20/40 to 20/22 after the 2 steps. The median follow-up was 11 (range, 9-17) months. No complications were observed and postoperative outcome was satisfactory.
  
  
  CONCLUSIONS
  Permitting correction of a broader range of high astigmatism with good accuracy, this combined approach minimizes excision of corneal stromal tissue and postoperative complications.
authors.affiliation: Department of Ophthalmology, Quinze-Vingts National Eye Hospital, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Loriaut
authors.forename: Otman
authors.initials: O
authors.lastname: Sandali
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Sanharawi
authors.forename: Isabelle
authors.initials: I
authors.lastname: Goemaere
authors.forename: Vincent
authors.initials: V
authors.lastname: Borderie
authors.forename: Laurent
authors.initials: L
authors.lastname: Laroche
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000601:surgery*; D003319:Corneal Stroma / Q000601:surgery*; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult