Correction of High Astigmatism by Autologous Astigmatic Lenticule Reshaping and Rotation

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Purpose: To explore the use of autologous astigmatic lenticule reshaping and rotation surgery to correct high astigmatism in conjunction with excimer laser technology to correct residual refractive error. Methods: Six patients with high astigmatism (8 eyes, all with astigmatism from −5.50 to −11.00 diopters [D]) seeking refractive error correction were enrolled. The following methods were used to correct refractive errors that could not be corrected by a single conventional surgery: (1) cutting of a customized lens using FLEx technology, (2) lifting of the corneal flap and reshaping the autologous astigmatic lenticule in situ using an excimer laser, and (3) rotation of the autologous astigmatic lenticule by 90°. Uncorrected distance visual acuity, subjective refraction, corneal topography, and anterior segment optical coherence tomography were performed preoperatively and postoperatively. Results: The efficacy and safety indices at 6 months postoperatively were 0.93 ± 0.18 and 1.06 ± 0.11, respectively, the spherical equivalent remained stable and close to emmetropia (−0.13 ± 0.70 D) from 1 to 6 months postoperatively, postoperative astigmatism was generally mildly undercorrected (−1.22 ± 0.43 D), and the difference in corneal curvatures at 2 mm from the apex of the cornea was significantly reduced compared to preoperatively ( P < .05); however, the corresponding values at 1 and 3 mm showed no difference. Conclusions: Correction of high astigmatism with autologous astigmatic lenticule reshaping and rotation surgery is tissue-sparing, predictable, and significantly improves postoperative visual acuity and quality. This method is feasible and safe, with predictability requiring further study. This novel surgical approach has potential for patients with high astigmatism that cannot be corrected by conventional refractive surgery. [ J Refract Surg . 2024;40(8):e554–e561.]

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