title: Use of keratoscopy, slit-lamp biomicroscopy, and retinoscopy in the management of astigmatism after penetrating keratoplasty.
abstract: Selective suture removal following corneal transplant surgery can facilitate the reduction of astigmatism. We present concepts concerning astigmatism analysis after keratoplasty related to suture compression by reviewing keratoscopy, slit-lamp biomicroscopy, and retinoscopy findings. Keratoscopy observations indicating tight sutures include peripheral indentation of the keratoscope rings, individual keratoscope ring images between tight sutures, and decentration of the corneal apex away from a tight suture. The utilization of the Van Loenen keratoscope at the slit-lamp in "dynamic keratoscopy" allows the surgeon to readily recognize these findings and also proves useful intraoperatively. Slit-lamp biomicroscope observations indicative of tight sutures include a doughnut of tissue compression, Kaye's epithelial white dots, and epithelial or endothelial stress lines. Retinoscopy observations demonstrate that tight sutures induce astigmatism with the narrowest side of the retinoscopy beam pointing directly toward the tightest suture. Astigmatism management plays a major role in the future success of ophthalmology and needs to be increasingly integrated into the practice of the general ophthalmologist.
authors.affiliation: University of Oklahoma, Dean A. McGee Eye Institute, Oklahoma City 73104.
authors.forename: J J
authors.initials: JJ
authors.lastname: Rowsey
authors.forename: W C
authors.initials: WC
authors.lastname: Fowler
authors.forename: M A
authors.initials: MA
authors.lastname: Terry
authors.forename: S V
authors.initials: SV
authors.lastname: Scoper
mesh_terms: D000368:Aged; D001251:Astigmatism / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D003315:Cornea / Q000473:pathology*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D013536:Suture Techniques / Q000009:adverse effects; D014787:Vision Tests / Q000295:instrumentation; D014945:Wound Healing