Refractive surgery for graft-induced astigmatism after penetrating keratoplasty for keratoconus

Ophthalmology. 1991 Dec;98(12):1786-92. doi: 10.1016/s0161-6420(91)32049-9.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Astigmatism / etiology
  • Astigmatism / surgery*
  • Follow-Up Studies
  • Humans
  • Keratoconus / surgery*
  • Keratoplasty, Penetrating / adverse effects*
  • Postoperative Complications
  • Suture Techniques
  • Treatment Outcome
  • Visual Acuity