Autologous astigmatic corneal lenticule rotation with stromal excimer ablation for high hyperopic astigmatism: 2-year follow-up

PurposeTo evaluate the long-term outcomes of a simultaneous lenticule rotation and excimer laser ablation for high hyperopic astigmatism, a technique addressing otherwise untreatable refractive errors.MethodsA 41-year-old female patient with a high refractive error (+3.75/-5.50 D) in her left eye underwent femtosecond laser-assisted FLEx, lenticule rotation, and excimer laser ablation. The procedure was performed to correct high astigmatism, which could not be treated with standard laser correction or phakic IOL implantation. Treatment parameters were adjusted to compensate for myopic shift due to centripetal lenticule shrinkage. Postoperative evaluations occurred at 3 months, 1 year, and 2 years.ResultsRefractive astigmatism was reduced by >5.0 D, with corneal astigmatism decreasing by 3.7 D. The lenticule integrated well without distortions. Minor epithelial remodeling occurred, but no structural complications were observed. The patient achieved stable visual acuity and high satisfaction over 2 years.ConclusionThis technique provides a stable, reversible alternative for high hyperopic astigmatism, preserving accommodation and avoiding refractive lens exchange. Corneal lenticule surgery may offer a viable option for patients with extreme hyperopic astigmatism. Further clinical studies are warranted to confirm its long-term efficacy