Effect of femtosecond laser-assisted arcuate keratotomy versus toric intraocular lens implantation on correction of astigmatism in cataract surgery: a systematic review and meta-analysis

Purpose To compare the efficacy of femtosecond laser-assisted arcuate keratotomy (FSAK) combined with non-toric intraocular lens (IOL) implantation versus Toric IOL (TIOL) implantation in correcting corneal astigmatism in cataract patients. Methods Relevant literature was searched in databases including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and SinoMed. Data from the included studies were extracted. A meta-analysis was conducted to compare the correction performance of FSAK combined with non-toric IOL implantation and TIOL implantation using postoperative refractive astigmatism, correction index, and uncorrected distance visual acuity (UDVA) outcomes. Publication bias assessment and sensitivity analysis were also performed. Results Five comparative studies were ultimately included in the meta-analysis. The TIOL group had smaller postoperative refractive astigmatism and a greater correction index compared to the FSAK group. The mean differences in postoperative refractive astigmatism and correction index between the two groups were − 0.19D (95% CI = 0.12 to 0.26, P < 0.01, I 2 = 7%) and − 0.09 (95% CI = − 0.18 to 0.00, P = 0.04, I 2 = 0%), respectively. We found no statistically significant difference in UDVA between the two groups (95% CI = − 0.01 to 0.11, P = 0.09, I 2 = 70%). Conclusions FSAK combined with non-toric IOL implantation was found to be less effective than TIOL implantation in correcting preoperative corneal astigmatism in cataract patients. The difference in the effectiveness of astigmatism correction between the two surgical methods seems to diminish, as the degree of preoperative corneal astigmatism decreases.