title: Refractive surgery for graft-induced astigmatism after penetrating keratoplasty for keratoconus.
abstract: Of a series of 201 corneal transplants for keratoconus over a 20-year period, 42 grafts (39 eyes of 38 patients) required further surgery because of intolerable astigmatism (range, -3 diopters [D] to -18 D; mean, 8.9 D). Relaxing incisions, compressive resuturing, and augmented relaxing incisions were the techniques used. All procedures resulted in a similar mean reduction in cylinder -3.6 to 5 D, but the outcome with augmented relaxing incisions was less predictable. Six grafts required two or more procedures for a satisfactory outcome. All patients had corrected visual acuity of 20/30 or better after surgery, and 75% had visual acuity of 20/20 or better. The cumulative time until 90% of the grafts had useful vision was 32 months after refractive surgery. Relaxing incisions offer the prospect of more rapid visual rehabilitation than compressive resuturing.
authors.affiliation: Pockington Transplantation Unit, Moorfields Eye Hospital, London.
authors.forename: C M
authors.initials: CM
authors.lastname: Kirkness
authors.forename: L A
authors.initials: LA
authors.lastname: Ficker
authors.forename: A D
authors.initials: AD
authors.lastname: Steele
authors.forename: N S
authors.initials: NS
authors.lastname: Rice
mesh_terms: D001251:Astigmatism / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D011183:Postoperative Complications; D013536:Suture Techniques; D016896:Treatment Outcome; D014792:Visual Acuity