Aims To compare the refractive and visual outcomes of femtosecond laser-assisted astigmatic keratotomy (FSAK) and toric intraocular lens (IOL) implantation for correcting astigmatism in cataract patients. Methods Studies were retrieved from the Ovid-Medline, EMBASE, Cochrane Central Register of Controlled Trials and Scopus which compared FSAK and toric IOL for astigmatism correction in cataract patients. Outcome measures included postoperative refractive cylinder, correction index, uncorrected distance visual acuity (UDVA), the proportion of patients achieving a residual refractive cylinder of 1.00 dioptre or less, target-induced astigmatism (TIA) and surgically induced astigmatism (SIA). The trial sequential analysis (TSA) was used to collect firm evidence supporting our conclusion. Results 9 studies encompassing 590 participants were analysed. The meta-analysis revealed that toric IOLs could result in less postoperative refractive cylinder and provide better UDVA compared with FSAK. The TSA disclosed strong evidence of lower postoperative refractive cylinder in the toric IOL group compared with that of the FSAK group. FSAK showed a smaller correction index and lower mean TIA and SIA compared with toric IOLs. Conclusions For cataract patients, both FSAK and toric IOLs are effective methods for correcting astigmatism. However, toric IOLs offer less postoperative astigmatism and result in better postoperative UDVA compared with FSAK. In vector analysis of astigmatism, toric IOLs can also produce higher TIA and SIA. Additionally, neither method is associated with severe untreatable complications. Therefore, the conclusion is that toric IOLs are the preferred choice for astigmatism correction in cataract patients and FSAK serves as a viable alternative when toric IOLs are contraindicated. All data relevant to the study are included in the article or uploaded as supplementary information.

中文翻译：

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飞秒激光辅助散光角膜切开术与环面人工晶状体植入术矫正白内障患者散光：系统评价和荟萃分析与试验序贯分析

目的 比较飞秒激光辅助散光角膜切开术 (FSAK) 和复曲面人工晶状体 (IOL) 植入术矫正白内障患者散光的屈光和视力结果。方法 从 Ovid-Medline、EMBASE、Cochrane 对照试验中心注册库和 Scopus 中检索研究，比较 FSAK 和环面 IOL 对白内障患者散光的矫正效果。结果指标包括术后屈光柱镜、矫正指数、未矫正远视力 (UDVA)、残余屈光柱镜达到 1.00 屈光度或更低的患者比例、目标诱发散光 (TIA) 和手术诱发散光 (SIA)。试验序贯分析（TSA）用于收集支持我们结论的确凿证据。结果 分析了 9 项涉及 590 名参与者的研究。荟萃分析显示，与 FSAK 相比，环面 IOL 可以减少术后屈光柱面，并提供更好的 UDVA。 TSA 披露了强有力的证据，表明与 FSAK 组相比，复曲面 IOL 组的术后屈光柱面较低。与散光 IOL 相比，FSAK 显示出较小的矫正指数以及较低的平均 TIA 和 SIA。结论对于白内障患者来说，FSAK和复曲面人工晶状体都是矫正散光的有效方法。然而，与 FSAK 相比，复曲面 IOL 术后散光较少，并且术后 UDVA 更好。在散光矢量分析中，复曲面 IOL 还可以产生更高的 TIA 和 SIA。此外，这两种方法都不会导致严重的无法治疗的并发症。因此，结论是，复曲面 IOL 是白内障患者散光矫正的首选，而当复曲面 IOL 禁忌时，FSAK 是可行的替代方案。与研究相关的所有数据都包含在文章中或作为补充信息上传。