Outcomes of Keratorefractive Surgery for Management of Postkeratoplasty Astigmatism in Keratoconus

To evaluate the outcomes of keratorefractive surgery for correction of postkeratoplasty astigmatism in keratoconus. In this retrospective study, surgical records of 45 eyes of 45 patients that underwent relaxing incisions with or without compressive sutures were evaluated. The minimum interval between complete suture removal and operation was 1 month. Location and extent of incisions were determined by topography. Intraoperative keratoscopy was performed to determine if compressive sutures were needed. Mean age at the time of corneal graft surgery was 29.6 ± 9.1 years. Mean interval between keratoplasty and keratorefractive surgery was 18.4 ± 8.8 months. Follow up period was 17.2 ± 12.3 months. Preoperative refractive astigmatism was 7.25 ± 1.59 D and keratometric astigmatism was 8.33 ± 2.37 D. After surgery, these values reached 4.14 ± 1.67 D and 4.42 ± 1.88 D, respectively (P<0.0001). Moderately 0.34 D myopic shift occurred. BSCVA was > 20/40 in 76.5% of the eyes before and 93.3% after surgery. Mean BSCVA in LogMAR was 0.28 (20/40) before and 0.17 (20/30) after surgery (one Snellen line increase of vision), P<0.0001. Keratorefractive surgery by relaxing incisions with or without compressive sutures is a safe and effective procedure to reduce postkeratoplasty astigmatism in keratoconus.