Standardized arcuate keratotomy for postkeratoplasty astigmatism

Purpose

To assess the effect of standardized, paired arcuate keratotomy (AK) on the change in astigmatism in postkeratoplasty eyes.

Setting

Moorfields Eye Hospital, London, United Kingdom.

Methods

A retrospective review was conducted of 20 eyes of 19 patients having the same AK procedure regardless of the magnitude of the preoperative astigmatism. Each eye had a pair of 60-degree arc length incisions placed in the corneal stroma. The incisions were 600 μm deep and 6.0 mm apart. The preoperative and postoperative refractions and complications were analyzed. Astigmatic change was analyzed without regard to axis, as surgically induced refractive change, and using a modified polar plot of change in astigmatism.

Results

The mean cylinder was reduced from −10.99 diopters (D) ± 4.26 (SD) to −3.33 ± 2.18 D. There was no significant change in the mean spherical equivalent. There was a strong correlation between the magnitude of the preoperative cylinder and the magnitude of the change in astigmatism (R²=0.76). In 3 eyes, the surgically induced axis of astigmatism was more than 15 degrees from that expected.

Conclusions

In postkeratoplasty eyes, the change in the magnitude of astigmatism induced by standardized AK was proportional to the preoperative magnitude of astigmatism. Arcuate nomograms for congenital astigmatism have no role in the management of astigmatism in postkeratoplasty eyes.