Manually Performed Limbal Relaxing Incisions vs Femtosecond Laser-guided Astigmatic Keratotomy

Sponsor
Assiut University (Other)
Overall Status
Unknown status
CT.gov ID
NCT03264534
Collaborator
(none)
80
2
19

Study Details

Study Description

Brief Summary

Astigmatic keratotomy (AK) is used to treat numerous refractive disorders, including congenital astigmatism, residual corneal astigmatism at the time of or following cataract surgery, post-traumatic astigmatism, and astigmatism after corneal transplantation.

Within the past few years, much consideration has been given to an evolutionary variant of the procedure, the limbal relaxing incision (LRI). By moving the incision farther to the periphery, cataract surgeons can safely and predictably remediate mild to moderate amounts of regular astigmatism at the time of cataract surgery by performing this incisional technique.

Recent technological developments have shifted ophthalmologist's attention from manually created LRIs and astigmatic keratotomy procedures to femtosecond laser-guided procedures. Femtosecond lasers offer superior incisional accuracy and reproducibility coupled with minimal effects on collateral tissues, achieving levels of safety and reproducibility exceeding those of mechanical techniques. A major clinical application of the femtosecond laser is for creating arcuate incisions that have a precise and accurate length, depth, angular position, and optical zone.

Condition or Disease Intervention/Treatment Phase
  • Procedure: limbal relaxing incisions
  • Procedure: astigmatic keratotomy
N/A

Detailed Description

Pre-operative evaluation:
  1. Close examination of the peripheral cornea by slit lamb, particularly in the areas where the incisions will be placed.

  2. Fundus examination to exclude other causes of diminution of vision.

  3. IOP measure.

  4. Precise manifest refraction, uncorrected visual acuity and best corrected visual acuity by snellen's chart.

  5. Standard keratometry to confirm diopters of corneal astigmatism.

  6. Corneal Tomography (Pentacam).

Surgical procedures:

LRIs are performed using topical anesthesia. Patients are instructed to fixate on the microscope light. Before surgery, the steep meridian was identified with a marker dyed with methylene blue with the patient sitting up right. A diamond knife is set at a depth of 0.600 mm to 0.650 mm based on the peripheral pachymetric readings over the area of intended incision. The goal was a maximum reduction in astigmatism without overcorrection in with-the rule cases and with little overcorrection in against the rule cases. In the case of an overcorrection, the LRI can be sutured without creating any irregular astigmatism.

Performing femtosecond laser-guided astigmatic keratotomy requires the parameters of length, position, depth and distance from the visual axis where the incisions will be created. The depth of our incisions is 85% of the corneal pachymetry in the area of the incision. We have set our distance from the visual axis at 8 mm. This information is all downloaded onto the femtosecond laser. Then, we begin the surgical procedure by docking the laser onto the cornea. An overlay of the incisions is then visible on the surgical screen. After treatment, we bring the patient to the operating microscope and open the incisions with a Sinskey hook. By using low energy, the incisions do not have significant effect until they are opened.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
80 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
Manually Performed Limbal Relaxing Incisions vs Femtosecond Laser-guided Astigmatic Keratotomy for Correction of Corneal Astigmatism After Phacoemulsification
Anticipated Study Start Date :
Mar 1, 2018
Anticipated Primary Completion Date :
Apr 1, 2019
Anticipated Study Completion Date :
Oct 1, 2019

Arms and Interventions

Arm Intervention/Treatment
Active Comparator: limbal relaxing incisions

Manually performed limbal relaxing incisions

Procedure: limbal relaxing incisions
Manually performed surgical procedure

Active Comparator: astigmatic keratotomy

femtosecond laser-guided astigmatic keratotomy

Procedure: astigmatic keratotomy
femtosecond laser guided surgical procedure

Outcome Measures

Primary Outcome Measures

  1. Keratometric reading [1 week]

    measured by Corneal Tomography (Pentacam)

Eligibility Criteria

Criteria

Ages Eligible for Study:
21 Years to 65 Years
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  1. patients who have undergo phacoemulsification.

  2. Clear cornea.

  3. Astigmatism from 1 diopter up to 4 diopters

Exclusion Criteria:
  1. corneal opacity.

  2. History of corneal surgery.

  3. Thin cornea.

  4. Other cause of diminution of vision rather than corneal astigmatism (eg: optic disc atrophy & maculopathy).

  5. Astigmatism less than 1 diopter and more than 4 diopters.

Contacts and Locations

Locations

No locations specified.

Sponsors and Collaborators

  • Assiut University

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
Ashraf Rashwan, Principal Investigator, Assiut University
ClinicalTrials.gov Identifier:
NCT03264534
Other Study ID Numbers:
  • 17200119
First Posted:
Aug 29, 2017
Last Update Posted:
Jan 11, 2018
Last Verified:
Aug 1, 2017
Individual Participant Data (IPD) Sharing Statement:
Undecided
Plan to Share IPD:
Undecided
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Additional relevant MeSH terms:

Study Results

No Results Posted as of Jan 11, 2018