Surgical Management Of Giant Astigmatism After Penetrating Keratoplasty

1
Surgical Management Of Giant Astigmatism After
Penetrating Keratoplasty

• O Beltaief, Kh Errais, W Zbiba, A Ouertani.
• Charles Nicolle University Hospital - Tunis-
  Tunisia
• Authors have no financial interest

2
INTRODUCTION

• Giant astigmatism can dramatically reduce final
  visual acuity and graft success in penetrating
  keratoplasty despite clear graft and absence of
  anatomic complications.
• Corneal surgery as relaxing incision or wedge
  resection could be used to reduce postoperative
  astigmatism.

3
PATIENTS METHODS

• Retrospective, nonrandomized, case series.
• 15 patients were operated on from 2002 to 2007.
• Postoperative astigmatism was superior to 5
  diopters in all cases with an average of 7.3 D
  (ranging from 5 to 11D).
• Incision surgery was
• wedge resection in 8 cases
• relaxing arcuate incision in 6 cases
• both in 1case.
• Mean follow up was 9 months.

4
REFRACTIVE RESULTS

• Preoperative visual acuity was 0.38 /- 0.18
• Postoperative VA increased to 0.54 /-0.14
  (ranging from 0.3 to 0.9)
• Visual acuity was increased in 12 cases (80) and
  reduced in 2 cases (13.4).

5
REFRACTIVE RESULTS

• Initial astigmatism 7.3/- 1.1 D
• Post-op astigmatism was reduced to 4.5 /-2.4 D
  (ranging from 1 to 7.4D)
• Astigmatism decrease average 2.8 D
• Sphere increased from -4.5 D to -7.5D.

6
RESULTS Wedge Resection

WR
4 years after WR Cyl 1.58D VA 20/25 (-6D)
Cyl 11D VA 20/60 K1 49.21 / K238.17
1 year after WR
7

RESULTS Wedge Resection
Pre-op VA 20/60
Post-op VA 20/30
8
ANATOMIC RESULTS

• Rejection occurred in 1 patients and was
  controlled by loco-regional treatment
• Loose sutures in 2 patients
• Infectious ulcer in 1 patient
• All grafts remained clear

9
CONCLUSIONS

• Incisional corneal surgery can improve high
  astigmatism and visual acuity after keratoplasty
  and prevent regrafting.
• Incisional techniques could become more
  predictable with femtosecond laser.