Arcuate Relaxing Incisions Guided by Corneal Topography for Postkeratoplasty Astigmatism
- 1 June 2006
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Cornea
- Vol. 25 (5), 545-557
- https://doi.org/10.1097/01.ico.0000214222.13615.b6
Abstract
Purpose: To determine if using corneal topography for planning arcuate relaxing incision placement for postkeratoplasty astigmatism improves clinical results. Methods: Twenty-six eyes with high levels (>5 diopters [D]) of postkeratoplasty astigmatism were studied in a nonrandomized, retrospective, observational case series. Relaxing incisions were placed in the peripheral graft in each steep topographic hemimeridian. The following data were measured: keratometric, topographic, and refractive vector analysis; nonvector astigmatism reduction; surface regularity and asymmetry (surface regularity index and surface asymmetry index); topography patterns; surgical design; and visual acuity. Results: Topographic analysis changed some aspect of the surgery in 51/52 incisions with a 15.7° mean change in incision location. The mean vector correction index (CI) was 0.89 to 0.92 for keratometric, topographic, and refractive indices. Sixty-five percent of eyes had surgically induced astigmatism (SIA) values within 2 D of the surgical goal. Eighty-one percent of eyes had at least a 50% reduction in net astigmatism and 85% had ≤3-D residual refractive cylinder. The mean logMAR visual acuity increased 2 lines. The preoperative and postoperative spherical equivalent showed a high correlation (ρ = 0.914, P = 0.000). The correlation between SIA and targeted induced astigmatism (TIA) was 0.56 (P = 0.003). There was a significant improvement in surface regularity index (P = 0.000) and surface asymmetry index (P = 0.05) values. No statistically significant correlations were found between total incision length and SIA or TIA, or between TIA and correction index. All patients had symmetric (58%) or asymmetric (42%) bowtie topographic patterns preoperatively with 35% achieving round/oval patterns postoperatively. Conclusions: Topography-guided relaxing incision offers an easy method to plan surgery and has some limited advantages over conventional techniques.Keywords
This publication has 36 references indexed in Scilit:
- Corneal Compression Sutures for the Reduction of Astigmatism After Penetrating KeratoplastyAmerican Journal of Ophthalmology, 1989
- The Effect of Suture Removal on Postkeratoplasty AstigmatismAmerican Journal of Ophthalmology, 1988
- The correction of post-keratoplasty astigmatismEye, 1987
- Refractive Keratoplasty for Disabling Astigmatism After Penetrating KeratoplastyAmerican Journal of Ophthalmology, 1987
- Relaxing Incisions with Augmentation Sutures for the Correction of Postkeratoplasty AstigmatismAmerican Journal of Ophthalmology, 1987
- Postoperative astigmatismSurvey of Ophthalmology, 1987
- Penetrating Keratoplasty for KeratoconusCornea, 1987
- Control of astigmatism after surgery and trauma: a new technique.British Journal of Ophthalmology, 1985
- Corneal Wedge Resections and Relaxing Incisions for Postkeratoplasty AstigmatismInternational Ophthalmology Clinics, 1983
- Surgical Correction of High Postkeratoplasty AstigmatismAmerican Journal of Ophthalmology, 1980