Abstract: Objective To compare the effectiveness of penetrating femtosecond laser-assisted arcuate keratotomy(FSAK)and manual arcuate keratotomy(mAK)in correcting mild-to-moderate regular corneal astigmatism in cataract patients. Methods This non-randomised cohort study involving 54 eyes, including 22 eyes that underwent mAK using a corneal depth marker knife and 32 eyes that received penetrating FSAK. Both groups underwent combined phacoemulsification and implantation of non-toric intraocular lenses. The primary outcomes included postoperative visual acuity and changes in corneal astigmatism at three months. Alpins vector analysis was used to compare target-induced astigmatism(TIA), surgically induced astigmatism(SIA), difference vector(DV), and correction index(CI)between the two groups. An independent-samples t-test was employed to compare the effects of astigmatism correction. Results Astigmatism in the mAK group decreased from(1.26±0.27)D to(0.90±0.59)D, while the FSAK group decreased from(1.24±0.27)D to(0.70±0.37)D, with no statistically significant difference between the two groups(P=0.133). Alpins analysis revealed that the SIA, DV, and CI of the mAK group were all higher than the FSAK group(P=0.238、P=0.133、P=0.191). Both groups showed a tendency toward undercorrection. Although intergroup differences were not statistically significant, the larger standard deviations oberved in the mAK group indicate diminished controllability and predictability. One case of corneal perforationwas observed in the mAK group. Conclusion Both FSAK and mAK can successfully correct mild-to-moderate regular astigmatism in cataract patients. However, FSAK exhibits superior safety and surgical predictability, albeit at a higher cost.

Key words: Femtosecond laser, Corneal depth knife, Arcuate keratotomy, Corneal astigmatism, Cataract surgery