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M. Turell, D. M. Meisler, W. D. Dupps, Jr., B. H. Jeng; Arcuate Keratotomy for the Treatment of Postkeratoplasty Astigmatism. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2338.
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© ARVO (1962-2015); The Authors (2016-present)
Postoperative astigmatism is a major factor that can limit visual recovery in patients who have undergone penetrating keratoplasty. The purpose of this study is to assess the outcomes of performing arcuate keratotomy (AK) in eyes with high astigmatism following penetrating keratoplasty.
A retrospective chart review was performed on all patients who underwent AK at our institution from 2003 to 2007. Uncorrected visual acuity, best corrected visual acuity, manifest refraction, and topographic cylinder were assessed both preoperatively, as well as at 1 week, 1 month, 3 months, and at last follow-up postoperatively.
Twelve eyes of 11 patients (5 female and 6 male, with mean patient age=72 years) underwent paired arcuate keratotomies for the treatment of postkeratoplasty astigmatism. The arc lengths ranged from 45-90 degrees, and the mean incision depth was 507 microns. The mean follow-up time was 15 months. Preoperatively, the mean refractive cylinder was 5.25 diopters (D) (range= 3.25-8.00 D), and postoperatively at last follow-up the mean refractive cylinder was 3.72 D (range= 0.50-10.00 D). Seven (58%) of twelve eyes gained a mean of 2.1 Snellen lines (range= 1-4 Snellen lines) of best spectacle corrected visual acuity (BSCVA). Four eyes achieved no change in BSCVA, but there was an average reduction in refractive cylinder of 5.20 D following AK in these patients. One patient lost 1 Snellen line of BSCVA, but this patient did benefit from a reduction in refractive cylinder of 6.50 D postoperatively. Of the 12 eyes, one underwent repeat AK with wedge resection and compression sutures because of inadequate effect from the first AK. In this series, the amount of change in refractive cylinder induced by AK did not correlate to the amount of preoperative refractive cylinder. There were no complications from any of the procedures.
Arcuate keratotomy appears to be a safe and effective method for reducing postkeratoplasty astigmatism. The change in magnitude of the cylinder induced by AK is difficult to predict, and in our series it was not proportional to the preoperative amount of cylinder.
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