Analysis of visual and refractive results after wedge resection for high astigmatism after penetrating keratoplasty in keratoconus

Abstract

Purpose To analyze visual and refractive results after wedge resection to correct high astigmatism after penetrating keratoplasty (PK) for keratoconus. Setting Cornea Unit of the Centro de Oftalmología Barraquer Barcelona, Spain. Design A retrospective quasi-experimental, before and after study. Methods Patients who developed high astigmatism or ectasia in the graft-host junction after PK were treated with wedge resection. The following variables were studied before the surgery, 1-year after and at the final visit: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive and topographic astigmatism and spherical equivalent. Vectorial analysis of the astigmatism changes was performed. Results Fifty-one eyes were included with a mean follow-up of 4.19 ± 3.09 years. Mean refractive astigmatism was 11.47 ± 3.57 diopters (D) pre-operatively and 4.79 ± 3.32 D at the final follow-up (p < 0.001). The mean centroid changed from 2.65 ± 11.82 D at 23 degrees preoperatively to 0.35 ± 5.86 D at 127 degrees postoperatively. Concerning spherical equivalent, the mean preoperative value was −3.10 ± 4.15 D and the mean postoperative value was −1.55 ± 3.41 D (p = 0.002). Mean pre-operative and final follow-up UDVA were 1.25 ± 0.27 and 0.84 ± 0.50 (p < 0.001). Mean Pre-op and final follow-up CDVA were 0.27 ± 0.19 and 0.24 ± 0.24. Conclusions Wedge resection is a useful surgical procedure to correct high astigmatism. It is a safe technique with moderate efficacy and may be considered as initial procedure of choice in high astigmatism due to long-term ectasia in the graft-host junction after PK for keratoconus.

Keratoconus: imaging modalities and management

“…Penetrating keratoplasty (PK) is a traditional full-thickness corneal transplant surgery typically reserved for advanced KCN [ 65 ] . A retrospective study suggested that wedge resection is secure and effective for correcting astigmatism resulting from ectasia in the graft-host junction after PK for KCN [ 67 ] . It reduces refractive astigmatism, improves visual acuity, and has moderate efficacy [ 67 ] .…”

“…A retrospective study suggested that wedge resection is secure and effective for correcting astigmatism resulting from ectasia in the graft-host junction after PK for KCN [ 67 ] . It reduces refractive astigmatism, improves visual acuity, and has moderate efficacy [ 67 ] . Therefore, it can be an initial choice for managing high astigmatism [ 67 , 68 ] .…”

Management of Post-Penetrating Keratoplasty Astigmatism by Photorefractive Keratectomy

“…Data from de Oteyza et al (11) shows that the average refractive astigmatism decreased from 11.47± 3.57 to 4.79 ± 3.32 diopters (D) during the pre-and postoperative periods, respectively (p <0.001).…”

Postoperative Astigmatism after Keratoplasty: A Systematic Review Meta-Analysis Based on PRISMA

“…Nevertheless, visual acuity often remains unsatisfactory [ 33 ]. Other approaches mentioned in the present study include surgical procedures such as suture tightening or selective suture removal as well as novel blunt dissection technique [ 5 ], intracorneal ring segments (ICRS) including Ferrara-type ICRS implantation [ 14 , 22 ], femtosecond laser-assisted ICRS implantation [ 13 , 14 , 19 , 24 , 34 ], relaxing incisions [ 23 ], corneal wedge resection [ 12 , 18 ], photorefractive keratectomy (PRK) [ 17 ], and deep intrastromal arcuate keratotomy with in situ keratomileusis (DIAKIK) [ 20 ].…”

“… Forest plot for visual acuity change using fixed- and random-effects model [ 5 , 6 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 ]. …”