Full-thickness astigmatic keratotomy combined with small-incision lenticule extraction to treat high-level and mixed astigmatism

Purpose: To explore the clinical effects of combined full-thickness astigmatic keratotomy and small-incision lenticule extraction (SMILE) in patients who are inoperable using SMILE alone. Methods: We included 13 eyes of 9 patients with high-level or mixed astigmatism who underwent full-thickness astigmatic keratotomy followed by SMILE (secondarily) to correct the residual refractive error. Results: Six months after SMILE, the spherical equivalent was reduced from 24.83 ± 3.26 D to 20.17 ± 0.38 D (P < 0.001), and the astigmatism was reduced from 5.12 ± 0.96 D to 0.21 ± 0.22 D (P < 0.001). The uncorrected and corrected (CDVA) distance visual acuities improved from 1.07 ± 0.62 to 0.02 ± 0.13 (P < 0.001) and from 0.08 ± 0.14 to 20.01 ± 0.14 (P = 0.002), respectively. The CDVA improved by 1 or 2 Snellen lines in 8 cases (61.5%), and there was no loss in CDVA. All procedures were completed without intraoperative or postoperative complications. Conclusions: This combined procedure was effective and safe for the treatment of high-level or mixed astigmatism.