title: Mechanized astigmatic arcuate keratotomy with the Hanna arcitome for astigmatism after keratoplasty.
abstract: OBJECTIVE
  To report the results of correction of post-keratoplasty astigmatism by arcuate keratotomy performed with the Hanna arcitome (Moria).
  
  
  METHODS
  Service 5, Hôpital des 15-20, Paris VI University, Paris, France.
  
  
  METHODS
  Forty eyes operated on for post-keratoplasty astigmatism using the Hanna arcitome were retrospectively studied. Paired symmetrical arcuate keratotomies were performed on the graft button. Mean follow-up was 10.8 months +/- 11.2 (SD). Outcome measures included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and subjective refraction. For statistical analysis, visual acuity data were transformed into logMAR units. The refractive data were analyzed using the Alpins method.
  
  
  RESULTS
  By a mean of 10.8 +/- 11.2 months after surgery, the UCVA had improved a mean of 0.28 +/- 0.46 lines, which was significant (P = .013). The BSCVA remained stable. The mean subjective cylinder was 8.84 +/- 3.00 diopters (D) preoperatively and 4.88 +/- 2.50 D postoperatively (P<.001). The changes in postoperative subjective cylinder values correlated with preoperative cylinder values (r(s) = 0.584; P<.0001). The subjective axis was modified by 20 degrees or less in 27 eyes (67.5%). The mean surgically induced astigmatism was 8.07 +/- 3.83 D and the mean correction index, 0.96 +/- 0.46. One microperforation occurred and required suturing. Incisions were off center in 1 case, and 2 patients had an allograft rejection after the procedure.
  
  
  CONCLUSIONS
  Arcuate keratotomy performed with the Hanna arcitome was effective in reducing post-keratoplasty astigmatism. The device enabled safer, easier arcuate incisions than with manual techniques. However, predictability and efficacy could be improved by a more accurate nomogram.
authors.affiliation: Service d'Ophtalmologie, Hopital d'Adultes de la Timone, Marseille, France. l.hoffart@wanadoo.fr
authors.forename: Louis
authors.initials: L
authors.lastname: Hoffart
authors.forename: Olivier
authors.initials: O
authors.lastname: Touzeau
authors.forename: Vincent
authors.initials: V
authors.lastname: Borderie
authors.forename: Laurent
authors.initials: L
authors.lastname: Laroche
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001251:Astigmatism / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D007646:Keratotomy, Radial / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012029:Refraction, Ocular; D012189:Retrospective Studies; D014792:Visual Acuity