Corneal wedge excision in the treatment of high astigmatism after penetrating keratoplasty.
OBJECTIVE
To report 5 cases of high astigmatism after penetrating keratoplasty (PK) treated with corneal wedge excisions.


METHODS
We report our experience of 5 patients treated with corneal wedge excisions for high astigmatism after PK. A thin sliver of cornea measuring between 0.1 and 0.2 mm in thickness was excised from just inside the graft-recipient interface. The length of the incision centered at the axis of the flatter meridian of the cornea and was extended over a range of 60-90 degrees. The wound was closed with interrupted 10-0 nylon sutures placed every 15 degrees. We also report, for the first time, both pre- and postoperative corneal topography in 3 of our patients who underwent wedge excisions.


RESULTS
The mean preoperative astigmatism was 15.2 D (range, 8.5-29.1 D). Postoperatively, after wedge excision, the mean astigmatism was reduced to 2.3 D (range, 1.9-3.7 D). The mean reduction in astigmatism was 12.9 D (range, 6.3-25.4 D).


CONCLUSIONS
Corneal wedge resection is an effective treatment for high astigmatism after PK. It may prove particularly useful in cases of high astigmatism or where other treatments are not appropriate. We believe that there is still a role for wedge resection as one of many tools to be used in the treatment of high post-PK astigmatism.
Department of Ophthalmology, St. Thomas' Hospital, London, UK. Daniel_Ezra@hotmail.com
Daniel G
DG
Ezra
Graham
G
Hay-Smith
Ali
A
Mearza
Mike G
MG
Falcon
D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000209:etiology / Q000601:surgery*; D003315:Cornea / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006801:Humans; D007640:Keratoconus / Q000601:surgery; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009757:Nylons; D013536:Suture Techniques; D013537:Sutures
D009757:Nylons