Effectiveness, Stability, and Influence Factors of Femtosecond Laser-Assisted Arcuate Keratotomy in Cataract Surgery: A Systematic Review and Meta-Analysis

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-05-07 DOI:10.1016/j.ajo.2025.04.037

Baoxian Zhuo , Wenqian Shen , Lei Cai , Shuang Ni , Jiying Shen , Jin Yang

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Abstract

PURPOSE

This study aimed to evaluate the effectiveness, stability, and influencing factors of femtosecond laser-assisted arcuate keratotomy (FSAK) performed during cataract surgery for correcting corneal astigmatism (CA).

METHODS

A systematic literature review was conducted to identify clinical trials adopting a pre-post study design. Data sources included electronic databases such as PubMed, Scopus, Web of Science, and Embase. Corneal astigmatism was assessed preoperatively and at multiple postoperative intervals: 1 month, 3 months, 6 months, and 1 year. Comparative analyses were conducted to determine the efficacy and stability over time. Subgroup analyses of CA reduction and absolute angle of error were performed based on potential influence factors including the type, depth, diameter, and platform of FSAK, magnitude and type of preoperative CA, and area of the study. Statistical analyses were performed using Review Manager 5.4.

DESIGN

Systematic review and meta-analysis.

RESULTS

Of the 40 articles initially identified, 20 met the final inclusion criteria. Follow-up durations ranged from 1 month to 2 years. Significant reduction in CA postoperative were observed at 1 month, 3 months, 6 months, and 1 year after surgery (mean difference [MD] = −0.55 D, −0.66 D, −0.43 D, and −0.67 D, respectively; all P < .02). CA between different postoperative time points were not significant (all P > .20). Subgroup analysis did not address the high heterogeneity. However, differences of CA reduction between subgroups based on type, depth, diameter, and platform of FSAK were significant. Penetrating FSAK, deeper incision, optical diameter at 8.5 mm were shown to introduce higher CA reduction (P = .005, .02, < .001, respectively). The effect achieved by different laser platforms were significantly different (P = .0002).

CONCLUSIONS

FSAK performed during cataract surgery effectively reduces corneal astigmatism, with stability observed from 1 month to 1 year postoperatively. The corrective performance is closely related to type, depth, diameter, and platform of FSAK.

This study was supported by the National Natural Science Foundation of China (Grant No. 82171039 and No. 82301191). Registration number: PROSPERO CRD 42024504481).

查看原文本刊更多论文

飞秒激光辅助白内障弓形角膜切开术的有效性、稳定性及影响因素：一项系统综述和meta分析。

目的评价飞秒激光辅助弓形角膜切开术（FSAK）在白内障手术中矫正角膜散光（CA）的有效性、稳定性及影响因素。方法采用系统的文献综述，确定采用研究前-研究后设计的临床试验。数据来源包括PubMed、Scopus、Web of Science和Embase等电子数据库。术前和术后多次评估角膜散光：1个月、3个月、6个月和1年。进行了比较分析，以确定随时间推移的疗效和稳定性。根据FSAK的类型、深度、直径和平台、术前CA的大小和类型以及研究面积等潜在影响因素进行CA复位和绝对误差角亚组分析。使用Review Manager 5.4进行统计分析。设计系统评价和元分析。结果在最初确定的40篇文章中，有20篇符合最终纳入标准。随访时间从1个月到2年不等。术后1个月、3个月、6个月和1年CA显著降低(平均差值[MD] = 分别为-0.55 D、-0.66 D、-0.43 D和-0.67 D；P < 0.02)。术后不同时间点CA差异无统计学意义（P < 0.20）。亚组分析没有解决高异质性的问题。然而，基于FSAK类型、深度、直径和平台的亚组间CA复位差异显著。穿透FSAK，切口越深，光学直径为8.5mm， CA还原率越高（P分别为 = 0.005,0.02,< 0.001）。不同激光平台的效果差异有统计学意义（P = 0.0002）。在白内障手术中进行fsak有效地减少了角膜散光，术后1个月至1年观察到稳定性。矫正效果与FSAK的类型、深度、直径和平台密切相关。本研究受国家自然科学基金（资助号：82171039和82301191）资助。注册号prospero CRD 42024504481)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.