Impact of advanced image-guided systems on correction of corneal astigmatism during FLACS.

Purpose: To determine the effectiveness of the correction of corneal astigmatism using the Alcon Image Guidance (IG) system vs manual marking in the orientation of femtosecond laser-assisted cataract surgery (FLACS).

Setting: Private practice, Albany, New York.

Design: Retrospective review.

Methods: Patients who underwent FLACS with IG and without IG were from January 2018 to June 2022 investigated. Variables including preoperative keratometry values, cylinder, spherical equivalent (SE), and visual acuity (VA) were collected, as well as the cyclorotation angle delta registered by IG, postoperative refractive cylinder, SE, and VA. The primary outcome was postoperative refractive cylinder in patients with IG compared with those without IG.

Results: A total of 160 eyes were included, with 103 eyes that had IG and 57 eyes that did not have IG. Postoperative cylinder was similar in those with IG (0.31 ± 0.36 diopters [D]) compared with those without IG (0.31 ± 0.37 D) ( P = .97). Average cyclorotation in the IG group was 2.82 ± 3.03 degrees. When cyclorotation was stratified into 3 groups (<2.8 degrees, 2.8 to 8.5 degrees, >8.5 degrees), no differences were found in postoperative refractive cylinder ( P = .35).

Conclusions: Patients who underwent FLACS with IG had similar postoperative cylinder outcomes compared with those without IG. This study suggests that the accommodation of cyclotorsion using an advanced IG system is similar to that obtained with manual marking techniques in patients having 2 D or less of astigmatism corrected.