Effects of astigmatic keratotomy combined with scleral tunnel incisions for the treatment of high astigmatism after penetrating keratoplasty

Gu,Zheng‑Yu; Ye,Min‑Jie; Ji,Kang‑Kang; Liao,Rong‑Feng

doi:10.3892/etm.2018.6968

Effects of astigmatic keratotomy combined with scleral tunnel incisions for the treatment of high astigmatism after penetrating keratoplasty

Authors:
- Zheng‑Yu Gu
- Min‑Jie Ye
- Kang‑Kang Ji
- Rong‑Feng Liao
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Affiliations: Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
Published online on: November 14, 2018 https://doi.org/10.3892/etm.2018.6968
Pages: 495-501

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Abstract

The present study aimed to evaluate the efficacy, predictability and safety of astigmatic keratotomy (AK) combined with scleral tunnel incisions in the treatment of high astigmatism after penetrating keratoplasty (PKP). Paired AK combined with scleral tunnel incisions was performed at the steep astigmatic meridian in 8 eyes of 8 patients with high keratometric astigmatism [>5.0 diopters (D)] after PKP. Pre‑ and post‑operative parameters, including uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction and keratometric astigmatism were evaluated. The Alpins method for vector analysis was used to evaluate the changes in keratometric astigmatism. The results indicated a statistically significant reduction in the mean keratometric astigmatism from 8.16±3.02 D pre‑operatively to 2.28±1.07 D at 3 months postoperatively. The mean UCVA improved from 0.95±0.24 logarithm of the minimum angle of resolution (logMAR) pre‑operatively to 0.61±0.17 logMAR at 3 months postoperatively (P<0.05). The mean BCVA improved from 0.41±0.18 logMAR pre‑operatively to 0.26±0.12 logMAR at 3 months postoperatively (P>0.05). Between 3 and 6 months after the surgery, the keratometric astigmatism remained stable. Alpins vector analysis demonstrated the relative predictability of this combined surgical treatment. The surgically induced astigmatism was significantly correlated with the target induced astigmatism (r=0.76, P<0.05). None of the patients had any severe complications. The present study indicated that AK combined with scleral tunnel incisions is an effective, relatively predictable and safe treatment for high astigmatism after PKP.

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1	Williams KA, Roder D, Esterman A, Muehlberg SM and Coster DJ: Factors predictive of corneal graft survival. Report from the Australian Corneal Graft Registry. Ophthalmology. 99:403–414. 1992. View Article : Google Scholar : PubMed/NCBI
2	Bochmann F and Schipper I: Correction of post-keratoplasty astigmatism with keratotomies in the host cornea. J Cataract Refract Surg. 32:923–928. 2006. View Article : Google Scholar : PubMed/NCBI
3	Nubile M, Carpineto P, Lanzini M, Calienno R, Agnifili L, Ciancaglini M and Mastropasqua L: Femtosecond laser arcuate keratotomy for the correction of high astigmatism after keratoplasty. Ophthalmology. 116:1083–1092. 2009. View Article : Google Scholar : PubMed/NCBI
4	Kim BK, Mun SJ, Lee DG, Kim JR, Kim HS and Chung YT: Full-thickness astigmatic keratotomy combined with small-incision lenticule extraction to treat high-level and mixed astigmatism. Cornea. 34:1582–1587. 2015. View Article : Google Scholar : PubMed/NCBI
5	Fronterrè A and Portesani GP: Relaxing incisions for postkeratoplasty astigmatism. Cornea. 10:305–311. 1991. View Article : Google Scholar : PubMed/NCBI
6	Ezra DG, Hay-Smith G, Mearza A and Falcon MG: Corneal wedge excision in the treatment of high astigmatism after penetrating keratoplasty. Cornea. 26:819–825. 2007. View Article : Google Scholar : PubMed/NCBI
7	Chang SM, Su CY and Lin CP: Correction of astigmatism after penetrating keratoplasty by relaxing incision with compression suture: A comparison between the guiding effect of photokeratoscope and of computer-assisted videokeratography. Cornea. 22:393–398. 2003. View Article : Google Scholar : PubMed/NCBI
8	Arenas E and Maglione A: Laser in situ keratomileusis for astigmatism and myopia after penetrating keratoplasty. J Refract Surg. 13:27–32. 1997.PubMed/NCBI
9	de Sanctis U, Eandi C and Grignolo F: Phacoemulsification and customized toric intraocular lens implantation in eyes with cataract and high astigmatism after penetrating keratoplasty. J Cataract Refract Surg. 37:781–785. 2011. View Article : Google Scholar : PubMed/NCBI
10	Akcay L, Kaplan AT, Kandemir B, Gunaydin NT and Dogan OK: Toric intraocular Collamer lens for high myopic astigmatism after penetrating keratoplasty. J Cataract Refract Surg. 35:2161–2163. 2009. View Article : Google Scholar : PubMed/NCBI
11	Wang J, Zhao J, Xu J and Zhang J: Evaluation of the effectiveness of combined femtosecond laser-assisted cataract surgery and femtosecond laser astigmatic keratotomy in improving post-operative visual outcomes. BMC Ophthalmol. 18:1612018. View Article : Google Scholar : PubMed/NCBI
12	Buzzonetti L, Petrocelli G, Laborante A, Mazzilli E, Gaspari M and Valente P: Arcuate keratotomy for high postoperative keratoplasty astigmatism performed with the intralase femtosecond laser. J Refract Surg. 25:709–714. 2009. View Article : Google Scholar : PubMed/NCBI
13	Çakır H, Genç S and Güler E: Circular keratotomy combined with wedge resection in the management of high astigmatism after penetrating keratoplasty. Eye Contact Lens. 25–June;2018.(Epub ahead of print). View Article : Google Scholar
14	Sy ME, Kovoor TA, Tannan A, Choi D, Deng SX, Danesh J and Hamilton DR: Combined astigmatic keratotomy and conductive keratoplasty to correct high corneal astigmatism. J Cataract Refract Surg. 41:1050–1056. 2015. View Article : Google Scholar : PubMed/NCBI
15	Wilkins MR, Mehta JS and Larkin DF: Standardized arcuate keratotomy for postkeratoplasty astigmatism. J Cataract Refract Surg. 31:297–301. 2005. View Article : Google Scholar : PubMed/NCBI
16	Weindler J, Pesch C, Hille K and Ruprecht KW: Lateral corneoscleral 6-mm-incision for reduction of against-the-rule astigmatism. Eur J Implant Ref Surg. 7:244–246. 1995. View Article : Google Scholar
17	Bachernegg A, Rückl T, Strohmaier C, Jell G, Grabner G and Dexl AK: Vector analysis, rotational stability, and visual outcome after implantation of a new aspheric toric IOL. J Refract Surg. 31:513–520. 2015. View Article : Google Scholar : PubMed/NCBI
18	Wade M, Steinert RF, Garg S, Farid M and Gaster R: Results of toric intraocular lenses for post-penetrating keratoplasty astigmatism. Ophthalmology. 121:771–777. 2014. View Article : Google Scholar : PubMed/NCBI
19	Iovieno A, Guglielmetti S, Capuano V, Allan BD and Maurino V: Correction of postkeratoplasty ametropia in keratoconus patients using a toric implantable Collamer lens. Eur J Ophthalmol. 23:361–367. 2013. View Article : Google Scholar : PubMed/NCBI
20	Wirbelauer C, Anders N, Pham DT and Wollensak J: Effect of incision location on preoperative oblique astigmatism after scleral tunnel incision. J Cataract Refract Surg. 23:365–371. 1997. View Article : Google Scholar : PubMed/NCBI
21	Heider W, Müller M, Schalnus R and Kaiser P: Corneal topography after cataract surgery with tunnel incision on a steeper meridian in inverse and oblique astigmatism. Ophthalmologe. 94:16–19. 1997.(In German). View Article : Google Scholar : PubMed/NCBI
22	Cleary C, Tang M, Ahmed H, Fox M and Huang D: Beveled femtosecond laser astigmatic keratotomy for the treatment of high astigmatism post-penetrating keratoplasty. Cornea. 32:54–62. 2013. View Article : Google Scholar : PubMed/NCBI
23	Fadlallah A, Mehanna C, Saragoussi JJ, Chelala E, Amari B and Legeais JM: Safety and efficacy of femtosecond laser-assisted arcuate keratotomy to treat irregular astigmatism after penetrating keratoplasty. J Cataract Refract Surg. 41:1168–1175. 2015. View Article : Google Scholar : PubMed/NCBI
24	Böhringer D, Dineva N, Maier P, Birnbaum F, Kirschkamp T, Reinhard T and Eberwein P: Long-term follow-up of astigmatic keratotomy for corneal astigmatism after penetrating keratoplasty. Acta Ophthalmol. 94:e607–e611. 2016. View Article : Google Scholar : PubMed/NCBI
25	Donnenfeld ED, Kornstein HS, Amin A, Speaker MD, Seedor JA, Sforza PD, Landrio LM and Perry HD: Laser in situ keratomileusis for correction of myopia and astigmatism after penetrating keratoplasty. Ophthalmology. 106:1966–1975. 1999. View Article : Google Scholar : PubMed/NCBI
26	Javadi MA, Feizi S, Yazdani S, Sharifi A and Sajjadi H: Outcomes of augmented relaxing incisions for postpenetrating keratoplasty astigmatism in keratoconus. Cornea. 28:280–284. 2009. View Article : Google Scholar : PubMed/NCBI
27	Day AC and Stevens JD: Predictors of femtosecond laser intrastromal astigmatic keratotomy efficacy for astigmatism management in cataract surgery. J Cataract Refract Surg. 42:251–257. 2016. View Article : Google Scholar : PubMed/NCBI
28	Kumar NL, Kaiserman I, Shehadeh-Mashor R, Sansanayudh W, Ritenour R and Rootman DS: IntraLase-enabled astigmatic keratotomy for post-keratoplasty astigmatism: on-axis vector analysis. Ophthalmology. 117(1228–1235): e12010.
29	Fares U, Mokashi AA, Al-Aqaba MA, Otri AM, Miri A and Dua HS: Management of postkeratoplasty astigmatism by paired arcuate incisions with compression sutures. Br J Ophthalmol. 97:438–443. 2013. View Article : Google Scholar : PubMed/NCBI
30	Akura J, Matsuura K, Hatta S, Kaneda S and Kadonosono K: Clinical application of full-arc, depth-dependent, astigmatic keratotomy. Cornea. 20:839–843. 2001. View Article : Google Scholar : PubMed/NCBI