title: Long-term follow-up of astigmatic keratotomy for corneal astigmatism after penetrating keratoplasty.
abstract: OBJECTIVE
  To report the long-term stability of paired arcuate corneal keratotomies (AKs) in patients with high regular postpenetrating keratoplasty astigmatism.
  
  
  METHODS
  Retrospective chart review of best-corrected visual acuity, refraction and keratometric values of 41 eyes with AK between 2003 and 2012.
  
  
  RESULTS
  Magnitude of median target induced astigmatism vector was 9.2 dioptres (Dpt). We reached a median magnitude of surgically induced astigmatism vector of 9.81 Dpt and a median magnitude of difference vector of 5.5 Dpt. In keratometry, we achieved a net median astigmatism reduction by 3.3 Dpt. The average correction index was 1.14, showing a slight overcorrection. Irregularity of keratometric astigmatism increased by 0.6 Dpt, and spherical equivalent changed by 1.75 Dpt. Monocular best spectacle corrected visual acuity increased from preoperatively 20/63 (0.5 logMAR) to 20/40 (0.3 logMAR) postoperatively. Median gain on the ETDRS chart was two lines. Long-term follow-up showed a median keratometric astigmatic increase by 0.3 Dpt per year.
  
  
  CONCLUSIONS
  Arcuate corneal keratotomies is a safe and effective method to reduce high regular corneal astigmatism following penetrating keratoplasty but has limited predictability. The long-term follow-up shows an increase of keratometric astigmatism by 0.3 Dpt/year, equalizing the surgical effect after 10 years.
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Böhringer
authors.affiliation: Department of Optometry, Aalen University of Applied Sciences, Aalen, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Dineva
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Maier
authors.affiliation: Eye Hospital, Klinikum Bremen-Mitte, Bremen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Birnbaum
authors.affiliation: Department of Optometry, Aalen University of Applied Sciences, Aalen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kirschkamp
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reinhard
authors.affiliation: Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Germany. philipp.eberwein@uniklinik-freiburg.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Eberwein
mesh_terms: D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000209:etiology / Q000601:surgery*; D003315:Cornea / Q000473:pathology / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery; D063171:Corneal Pachymetry; D019781:Corneal Topography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D007646:Keratotomy, Radial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology
keywords: astigmatism; keratometry; keratoplasty; keratotomy