Outcomes of augmented relaxing incisions for postpenetrating keratoplasty astigmatism in keratoconus.

Abstract

PURPOSE:

To determine the outcomes of augmented relaxing incisions (relaxing incisions and counter-quadrant compression sutures) as graft refractive surgery (GRS) in keratoconic eyes.

PATIENTS AND METHODS:

This interventional case series included keratoconic eyes undergoing GRS for intolerable amounts of postpenetrating keratoplasty (PKP) astigmatism. Relaxing incisions were made in the graft-host interface down to Descemet membrane on both sides of the steepest meridian. Interrupted 10-0 nylon compression sutures were added in the opposite meridian to overcorrect astigmatism. Selective suture removal was initiated after 3-6 weeks to achieve tolerable amounts of astigmatism. Best-corrected visual acuity and refractive and keratometric astigmatisms were compared before and after the operation using simple subtraction and vector analysis methods.

RESULTS:

Overall, 77 eyes of 77 patients including 51 (66.2%) male and 26 (33.8%) female subjects with mean age of 30.0 +/- 10.2 years at the time of PKP were studied. Average follow-up was 61.5 +/- 33.5 months after PKP and 40.8 +/- 29.3 months after GRS. Mean best-corrected visual acuity improved from 0.31 +/- 0.26 logMAR (20/40) before GRS to 0.18 +/- 0.12 logMAR (20/30) postoperatively (P < 0.001). Mean preoperative and postoperative values for refractive astigmatism, keratometric astigmatism, and spherical equivalent refractive error were 6.8 +/- 1.4 and 3.9 +/- 1.6 diopters (D) (P < 0.001), 7.9 +/- 1.9 and 4.5 +/- 2.2 D (P < 0.001), and -2.0 +/- 2.9 and -3.24 +/- 2.8 D (P < 0.001), respectively. Vector analysis demonstrated that refractive and keratometric astigmatisms were reduced by 4.8 and 5.9 D, respectively.

CONCLUSIONS:

GRS using augmented relaxing incisions reduces post-PKP astigmatism in keratoconic eyes; however, it causes a slight myopic shift.

• Authors: Mohammad A Javadi, Sepehr Feizi, Shahin Yazdani, Ali Sharifi, Hamid Sajjadi
• Journal: Cornea (Cornea) Vol. 28 Issue 3 Pg. 280-4 (Apr 2009) ISSN: 1536-4798 [Electronic] United States
• PMID: 19387228 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Astigmatism (etiology, surgery)
• Cornea (surgery)
• Female
• Follow-Up Studies
• Humans
• Keratoconus (surgery)
• Keratoplasty, Penetrating (adverse effects)
• Male
• Middle Aged
• Postoperative Complications
• Refractive Surgical Procedures
• Suture Techniques
• Treatment Outcome
• Visual Acuity (physiology)
• Young Adult