Correction of post-keratoplasty astigmatism with keratotomies in the host cornea

Abstract

We evaluated the effects of astigmatic keratotomy performed in the host cornea to treat astigmatism after penetrating keratoplasty. In 11 patients with high post-keratoplasty astigmatisms (mean 9.02 diopters [D]; range 5.5 to 17.4 D), an arcuate keratotomy was performed in the host cornea. The mean incision depth was 575 mum (range 500 to 600 mum). The refractive data were analyzed using the Alpins method for vector analysis. The mean keratometric cylinder decreased to 3.41 D (range 0.9 to 5.3 D). The mean surgically induced astigmatism achieved was 7.3 +/- 3.89, with a mean correction index of 0.82 +/- 0.34. No microperforations were observed, and neither graft decompensation nor rejection occurred. Astigmatic keratotomy performed in the host cornea was a safe procedure to reduce post-keratoplasty astigmatism. The procedure offers the potential for correction of the astigmatism and has satisfactory predictability.

Femtosecond-assisted astigmatic keratotomy for post-keratoplasty irregular astigmatism

“…[3][4][5][6][7] Due to the minimally invasive nature of this technique, it is commonly preferred for PPK astigmatism treatment. [3][4][5][6][7] The technique is similar to limbal relaxing incisions, with the incisions placed inside the donor recipient interface. The major limitations with freehand or mechanical astigmatic incisions are the technical difficulties (especially in PPK patients with irregular, nonorthogonal astigmatism) such as incision predictability that make this technique challenging.…”

“…1,2 Arcuate astigmatic keratotomy (AK) is popular among corneal surgeons since it allows the reduction of high amounts of astigmatism in PPK patients. [3][4][5][6][7][8] Despite that, technical difficulties such as incision uniformity, reproducibility, and predictability are challenging. [5][6][7] We describe the technique of AK using a femtosecond laser in a keratoconic patient with irregular astigmatism 28 years after penetrating keratoplasty (PKP).…”

Management of post-keratoplasty astigmatism

“…These include freehand techniques, 58,61 mechanical techniques using devices such as the Hanna arcitome, 62 and femtosecond laser ablations. 63,64 Incisions can be placed in the donor graft button, 58 in the host cornea, 65 or in the graft-host junction. 66 The number of incisions, incision length and depth, and patient factors contribute to the outcome of AK.…”

Safety and efficacy of femtosecond laser–assisted arcuate keratotomy to treat irregular astigmatism after penetrating keratoplasty

“…[6][7][8] Surgical procedures such as relaxing incisions and wedge resections are used for more advanced astigmatism but have been associated with unpredictable results and high complication rates. [9][10][11][12][13][14] In 2006, the femtosecond laser was used to create PKP incisions (top-hat wound configuration) and to perform femtosecond laser-assisted astigmatic keratotomy (AK). [15][16][17] Kiraly et al 18 and Harissi-Dagher and Azar 19 were the first to report the use of a femtosecond laser to create the arcuate incisions for the treatment of post-PKP astigmatism, and they found it to be safe and effective.…”