title: Safety and efficacy of femtosecond laser-assisted arcuate keratotomy to treat irregular astigmatism after penetrating keratoplasty.
abstract: OBJECTIVE
  To determine the refractive efficacy, predictability, stability, and complication rate of Intralase femtosecond laser-assisted astigmatic keratotomy (AK) for irregular astigmatism after penetrating keratoplasty (PKP).
  
  
  METHODS
  Ophthalmology Department, Hôtel-Dieu, Paris, France.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Femtosecond laser-assisted AK was performed to treat high irregular astigmatism (>5.0 diopters [D]) after PKP. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, vector analysis, and complications were evaluated.
  
  
  RESULTS
  The study evaluated 62 eyes of 57 patients over a mean follow-up of 28 months ± 3.5 (SD). Preoperatively, the mean CDVA was 0.51 ± 0.26 logMAR and the mean UDVA was 0.98 ± 0.24 logMAR; 6 months postoperatively, the mean CDVA and UDVA improved to 0.40 ± 0.22 logMAR and 0.60 ± 0.2 logMAR, respectively (both P < .01). The mean preoperative absolute astigmatism was 7.1 ± 1.72 D; 6 months postoperatively, the mean refractive astigmatism was 2.6 ± 2.4 D (P < .001). The UDVA, CDVA, and astigmatism remained stable up to the end of follow-up. The efficacy index was 0.81 at 6 months and 0.67 at 2 years. There were 2 cases of microperforation, 3 cases of infectious keratitis, 3 graft rejection episodes, and 1 case of endophthalmitis. Overcorrection occurred in 12 eyes.
  
  
  CONCLUSIONS
  Femtosecond laser-assisted AK was effective in reducing irregular astigmatism after PKP. Predictability of astigmatism correction is variable over time with a decrease in the efficacy index 2 years postoperatively. Refinement of the treatment nomogram for femtosecond laser-assisted AK for high astigmatism after PKP remains a major issue.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Department of Ophthalmology (Fadlallah, Mehanna, Saragoussi, Amari, Legeais), Hôtel-Dieu/Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Descartes University, Université Pierre et Marie Curie (Fadlallah), Sorbonne University, Saint Joseph University, and Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche Scientifique 872 - Le Centre de Recherches des Cordeliers (Mehanna), Team 17, Paris, France; the Faculty of Medicine (Fadlallah, Chelala), Beirut, Lebanon. Electronic address: fadlallah2000@hotmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Fadlallah
authors.affiliation: From the Department of Ophthalmology (Fadlallah, Mehanna, Saragoussi, Amari, Legeais), Hôtel-Dieu/Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Descartes University, Université Pierre et Marie Curie (Fadlallah), Sorbonne University, Saint Joseph University, and Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche Scientifique 872 - Le Centre de Recherches des Cordeliers (Mehanna), Team 17, Paris, France; the Faculty of Medicine (Fadlallah, Chelala), Beirut, Lebanon.
authors.forename: Chadi
authors.initials: C
authors.lastname: Mehanna
authors.affiliation: From the Department of Ophthalmology (Fadlallah, Mehanna, Saragoussi, Amari, Legeais), Hôtel-Dieu/Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Descartes University, Université Pierre et Marie Curie (Fadlallah), Sorbonne University, Saint Joseph University, and Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche Scientifique 872 - Le Centre de Recherches des Cordeliers (Mehanna), Team 17, Paris, France; the Faculty of Medicine (Fadlallah, Chelala), Beirut, Lebanon.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Saragoussi
authors.affiliation: From the Department of Ophthalmology (Fadlallah, Mehanna, Saragoussi, Amari, Legeais), Hôtel-Dieu/Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Descartes University, Université Pierre et Marie Curie (Fadlallah), Sorbonne University, Saint Joseph University, and Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche Scientifique 872 - Le Centre de Recherches des Cordeliers (Mehanna), Team 17, Paris, France; the Faculty of Medicine (Fadlallah, Chelala), Beirut, Lebanon.
authors.forename: Elias
authors.initials: E
authors.lastname: Chelala
authors.affiliation: From the Department of Ophthalmology (Fadlallah, Mehanna, Saragoussi, Amari, Legeais), Hôtel-Dieu/Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Descartes University, Université Pierre et Marie Curie (Fadlallah), Sorbonne University, Saint Joseph University, and Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche Scientifique 872 - Le Centre de Recherches des Cordeliers (Mehanna), Team 17, Paris, France; the Faculty of Medicine (Fadlallah, Chelala), Beirut, Lebanon.
authors.forename: Belkacem
authors.initials: B
authors.lastname: Amari
authors.affiliation: From the Department of Ophthalmology (Fadlallah, Mehanna, Saragoussi, Amari, Legeais), Hôtel-Dieu/Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Descartes University, Université Pierre et Marie Curie (Fadlallah), Sorbonne University, Saint Joseph University, and Institut National de la Santé et de la Recherche Médicale Unite Mixte de Recherche Scientifique 872 - Le Centre de Recherches des Cordeliers (Mehanna), Team 17, Paris, France; the Faculty of Medicine (Fadlallah, Chelala), Beirut, Lebanon.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Legeais
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001251:Astigmatism / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery; D003319:Corneal Stroma / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D054018:Lasers, Excimer / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology