We performed a prospective study of relaxing incisions with augmentation
sutures in 21 patients who were unable to wear
spectacles or
contact lenses after
penetrating keratoplasty because of high
astigmatism. The mean preoperative
astigmatism was 9.37 diopters (range, 4.50 to 14.50 diopters), and the mean postoperative
astigmatism was 3.73 diopters (range, 0.00 to 7.00 diopters). The net decrease in
astigmatism was 6.56 diopters (range, 1.00 to 11.00 diopters), which represents a 67% decrease in
astigmatism. The mean vector corrected change in
astigmatism was 8.40 diopters (86%). These results were compared with those of our previous study of relaxing incisions without
sutures. Overall, there was a significantly greater decrease in
astigmatism (67% vs 47%, P = .009) when augmentation
sutures were placed 90 degrees away from the relaxing incisions. Furthermore, in patients with more than 8.50 diopters of
astigmatism, relaxing incisions with
sutures yielded a much greater reduction in
astigmatism compared with relaxing incisions without
sutures (70% with
sutures vs 39% without
sutures, P = .002). We recommend relaxing incisions with augmentation
sutures as the initial
surgical procedure in eyes with more than 8.50 diopters of
astigmatism.