Surgical Correction of Astigmatism After Penetrating Keratoplasty

  • David H. HaightEmail author


For many decades, penetrating keratoplasty (PKP) has been the procedure of choice for patients requiring surgical correction for a variety of corneal diseases resulting in a loss of optical clarity from trauma, infection, dystrophy, or significant irregularity due to ectasia. In recent years, there has been a move away from penetrating keratoplasty in favor of various endothelial keratoplasty (EK) techniques. EK procedures have now surpassed PKP procedures as the most commonly performed type of corneal transplant surgery. Additionally, there has been recent renewed interest in lamellar keratoplasty techniques such as DALK for anterior stromal dystrophy, opacity, and even ectasia. Nonetheless, there still remains a role, which will likely continue in the foreseeable future, for the use of penetrating keratoplasty.


Astigmatism Penetrating Keratoplasty Corneal Relaxing Incision Corneal Wedge resection Femtosecond Laser PRK LASIK 

Supplementary material

Video 12.1

Manual Corneal Relaxing Incision Technique


  1. 1.
    Mahjoub SB, AU Y-K. Astigmatism and tissue shaped disparity in penetrating keratoplasty. Ophthalmic Surg. 1990;21:187–90.PubMedGoogle Scholar
  2. 2.
    Van Rij G, Cornell FM. Wearing go, III, Wilson LA, Beekheys WH. Post-operative astigmatism after central vs. eccentric penetrating keratoplasty. Am J Ophthalmol. 1985;99:317–20.CrossRefPubMedGoogle Scholar
  3. 3.
    Bourne WM, Davison JA, O’Fallon WM. The effects of oversize donor buttons on post-operative intra-ocular pressure in corneal curvature in aphakic penetrating keratoplasty. Ophthalmology. 1982;189:242–6.CrossRefGoogle Scholar
  4. 4.
    Olson RJ. Prevention of astigmatism in corneal transplant surgery. Int Ophthalmol Clin. 1988;28(1):37–45.CrossRefPubMedGoogle Scholar
  5. 5.
    Serdarvic N, Renard GC, Pouliquen Y. Randomized clinical trials of penetrating keratoplasty; before and after suture removal. Comparison of intra-operative and post-operative suture adjustment. Ophthalmology. 1995;102:1497–503.CrossRefGoogle Scholar
  6. 6.
    Stainer GA, Pearl T, Binder PS. Controlled reduction of post-keratoplasty astigmatism. Ophthalmology. 1982;89:668–76.CrossRefPubMedGoogle Scholar
  7. 7.
    Binder PS. Selective suture removal can reduce post-keratoplasty astigmatism. Ophthalmology. 1985;92:1412–6.CrossRefPubMedGoogle Scholar
  8. 8.
    McNeill GI, Wessels IF. Adjustment of single continuous suture to control astigmatism after penetrating keratoplasty. Refract Corneal Surg. 1989;5:216–23.PubMedGoogle Scholar
  9. 9.
    Buzard KA. Repair of the micro dehiscence to correct post keratoplasty astigmatism. Ophthalmic Surg. 1989;12:876–82.Google Scholar
  10. 10.
    Troutman RC, Swinger C. Relaxing incision for control of post-operative astigmatism following keratoplasty. Ophthalmic Surg. 1980;11:117–20.PubMedGoogle Scholar
  11. 11.
    Poole TR, Flicker LA. Astigmatic keratotomy for post-keratoplasty astigmatism. J Cataract Refract Surg. 2006;32(7):1175–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Troutman RC. Microsurgical control of corneal astigmatism in cataract and keratoplasty. Trans Acad Ophthalmol Laryngol. 1973;77:OP563–72.Google Scholar
  13. 13.
    Ghanem RC. Azerdt. Femtosecond arcuate wedge shape resection to correct high residual astigmatism after penetrating keratoplasty. Journal cataract and refractive. Surgery. 2006;32:1415–9.Google Scholar
  14. 14.
    Kymionis G, Colbertson WW. Femtosecond assisted astigmatic Keratotomy for post keratoplasty irregular astigmatism. J Cataract Refract Surg. 2009;35(1):11–3.CrossRefPubMedGoogle Scholar
  15. 15.
    Kumar NL, Kaiserman I, Shehadeh-Mashor R, Sansanayudh W, Ritenour R, Rootmand S. Intralase enabled astigmatic keratotomy for post keratoplasty irregular astigmatism: on axis vector analysis. Ophthalmology. 2010;117(6):122–1235.CrossRefGoogle Scholar
  16. 16.
    Buzzonetti L, Petrocelli G, Laborante A, Mezzilli E, Gaspari M, Valente P. Arcuate keratotomy for high post-operative keratoplasty astigmatism performed with the intralase femtosecond laser. J Refract Surg. 2009;25(8):709–14.CrossRefPubMedGoogle Scholar
  17. 17.
    Cleary C, Tang M, Ahmed H, Fox M, Huang D. Beveled femtosecond laser astigmatic keratotomy for the treatment of high astigmatism post-penetrating keratoplasty. Cornea. 2013;32(1):54–62.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Prazeres TM, Souza AC, Pereira NC, Ursulino F, Grupenmacher L, DeSouza LB. Intrastromal corneal ring segment implantation by femtosecond laser for the correction of residual astigmatism after penetrating keratoplasty. Cornea. 2011;30(12):1293–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Coskunseven E, Kymionis GD, Talu H, Aslan E, Diakonis VF, Bouzoukis DI, Pallikairs I. Intrastromal corneal ring segment implantation with the femtosecond laser in a post keratoplasty patient with recurrent keratoconus. J Cataract Refract Surg. 2007;33(10):1808–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Bilgihan K, Ozdek SC, Akata F, Hasanreisojlu B. Photorefractive keratectomy for post-penetrating keratoplasty, myopia, and astigmatism. J Cataract Refract Surg. 2000;26(11):1590–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Yoshida K, Tazawa Y, Demong TT. Refractive results of post-penetrating keratoplasty, photorefractive keratectomy. Ophthalmic Surg Lasers. 1999;30(5):354–9.PubMedGoogle Scholar
  22. 22.
    Bansel AK. Photo-astigmatic refractive keratectomy for correction of astigmatism after keratoplasty. J Refract Surg. 1999;15(2 suppl):S243–5.Google Scholar
  23. 23.
    Tuunanen TH, Ruusuvaara PJ, Uusitalo RJ, Terivo TM. Photo-astigmatic keratectomy for correction of astigmatism and corneal grafts. Cornea. 1997;16(1):48–53.CrossRefPubMedGoogle Scholar
  24. 24.
    Kovoor TA, Mohamed E, Cavanaugh D, Bowman RW. Outcomes of LASIK and PRK in previous penetrating corneal transplant recipients. Eye Contact Lens. 2009;35(5):242–5.CrossRefPubMedGoogle Scholar
  25. 25.
    Buzard K, Febbraro JL, Fundingsland BR. Laser in-situ keratomileusis for the correction of residual ametropia after penetrating keratoplasty. J Cataract Refract Surg. 2004;30(5):1006–13.CrossRefPubMedGoogle Scholar
  26. 26.
    Kohnen T, Buhren J. Corneal first surface aberration analysis of the biomechanical effects of astigmatic keratotomy and a micro keratome cut after penetrating keratoplasty. J Cataract Refract Surg. 2005;31(1):185–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Alioj L, Javaloy J, Osman AA, Galvis V, Tello A, Harounh E. Laser in-situ keratomileusis to correct post-keratoplasty astigmatism; one-step vs. two-step procedure. J Cataract Refract Surg. 2004;30(11):2303–10.Google Scholar
  28. 28.
    Alfonso JF, Lisa C, Abdelhamid A, Montes-Mico R, Poo-Lopez A, Ferrer-Blasco T. Posterior chamber phakic intraocular lenses after penetrating keratoplasty. J Cataract Refract Surg. 2009;35:1116–73.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.New YorkUSA
  2. 2.New YorkUSA

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