• Melanie Corbett
  • Nicholas Maycock
  • Emanuel Rosen
  • David O’Brart


Transplantation of corneal tissue can have relatively little effect on corneal shape when the layers removed and replaced are thin but can have more profound effects when thicker or even full-thickness.

Corneal steepening can result from tissue compression by tight sutures or tissue contraction as a result of cautery or scarring. Corneal flattening can result from suture loosening or the graft over-riding the host. Irregular astigmatism can result from a combination of focal changes at different sites or a torsional effect from horizontal wound misalignment.

After keratoplasty, topography may be prolate if steep centrally, oblate if flat centrally or mixed. In astigmatism, the ends of the bow ties tend to be flattened due to the graft-host junction and may be of different sizes or at an angle in asymmetric astigmatism. Irregular astigmatism may have a variety of patterns including steep/flat, horseshoe or trefoil.

In all types of anterior segment surgery, incisions have greater effect if they are longer, deeper, more vertical and nearer the centre of the cornea. Wound misalignment, either horizontally or vertically, can cause irregular astigmatism. Sutures should be sufficiently long, deep and perpendicular to the wound (radial in the case of a keratoplasty) to support the tissues in the appropriate shape.


Corneal topography Keratoplasty Corneal graft Corneal transplant Corneal sutures Tight sutures Loose sutures Astigmatism Bow tie Corneal steepening Corneal flattening Horizontal torsion Wound misalignment 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Melanie Corbett
    • 1
  • Nicholas Maycock
    • 2
  • Emanuel Rosen
    • 3
  • David O’Brart
    • 4
  1. 1.Imperial College Healthcare NHS TrustLondonUK
  2. 2.University Hospital Coventry and WarwickshireCoventryUK
  3. 3.ManchesterUK
  4. 4.Department of OphthalmologySt. Thomas HospitalLondonUK

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