OCT-based femtosecond laser-assisted corneal relaxing incision for correcting corneal astigmatism in cataract patients

Objective The aim of this study was to compare the clinical effectiveness, precision, and safety profile of femtosecond laser-assisted versus conventional manual corneal relaxing incisions in eyes undergoing cataract surgery, with quantitative assessment performed using anterior segment optical coherence tomography (OCT). Methods A total of 87 patients (87 eyes) with cataracts were enrolled based on this retrospective investigation. Participants were assigned to either the femtosecond laser-assisted group (Femtosecond group, n = 52) or the conventional manual incision group (Manual group, n = 35). Outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), surgically induced astigmatism (SIA), difference vector (DV), angle of error (AE), correction index (CI), and residual astigmatism (RA). Cross-sectional imaging of corneal relaxing incisions was performed postoperatively using anterior segment OCT to quantitatively assess actual incision depth and calculate the deviation. Results In both cohorts, UDVA and CDVA measured at one and three months post-surgery demonstrated significant improvement relative to preoperative values ( P < 0.05). At the three-month postoperative time point, UDVA in the Femtosecond group surpassed that observed in the Manual group ( P < 0.05). Compared with the Manual group, the Femtosecond group exhibited a greater magnitude of induced SIA by three months after surgery ( P < 0.05), alongside smaller values for DV, AE, and RA ( P < 0.05). The target incision depth was 450 μm (80% of corneal thickness). Anterior segment OCT evaluations conducted at 1 month postoperatively, the Femtosecond group demonstrated significantly smaller mean depth deviation (−2.89 μm vs. −21.14 μm, P < 0.001) and absolute deviation (7.23 μm vs. 25.71 μm, P < 0.001) compared to the Manual group. Incision morphology appeared more consistent, and the overall complication rate was lower in the Femtosecond group when compared with the Manual group (13.5% vs. 57.1%, P < 0.001). Conclusion Based on objective OCT evaluation, femtosecond laser-assisted corneal relaxing incision demonstrated superior predictability, precision, and safety compared to the traditional manual technique for correcting corneal astigmatism in cataract patients, achieving better refractive correction outcomes.