Evaluation of the efficacy of scar revision at graft-recipient junction for reduction of astigmatism incidence following penetrating keratoplasty

Astigmatism is a common complication of penetrating (PK) and Lamellar (LK) keratoplasty that may cause surgical failure due to visual disturbances. In this study, the efficacy of scar revision just at the surgical incision was evaluated. In this prospective interventional case-series study, scar revision was performed in nineteen post-PK or LK astigmatism patients. In all patients, three months after suture removal, refraction, keratometry and topography was performed. Using Mendez gage, 2 gaps of, 45 degrees for astigmatisms of less than 6 diopter, and 60 degrees for astigmatisms of more than 6 diopters was induced in steep meredians. Magnitude of refractive error and corneal keratometry before and at least 3 months after intervention were measured. Mean age of patients was 30 (19-81) years. The reason for PK was KCN in 15, post-traumatic corneal scar in 2, and pseudophakic bullous keratopathy in 2 cases. Only in two cases, micro-perforation and leakage happened that were managed by eye patching alone. No other significant complication was observed during follow up period. The mean pre-operative astigmatism was 8.1 ± 4.5 (3.00-24.00) D which decreased to 5.4 ± 3.7 (0.5-14.00) D post-operatively (p<0.05). Scar revisions just at the graft junction, induced statistically significant corrective effect in post-PK astigmatism and can be used as an appropriate method for treatment of theses patients.