Grütters G., Reichelt J. A., Nölle B.

Department of Ophthalmology, Hegewischstrasse 2, D-24105 Kiel

Objective: High astigmatism following penetrating keratoplasty often requires secondary surgical intervention and is therefore expensive. Astigmatism- oriented penetrating keratoplasty (AOPKP) allows to reduce postoperative astigmatism ("compensation" group). In AOPKP keratoplasty is performed with knowledge of the astigmatism in the donor and the recipient` s eye. From our previous pilot study we would like to present a single case of high postoperative astigmatism after penetrating keratoplasty with the axis of the donor cornea in the same orientation as the host cornea ("addition" group).
Methods: A female 53-year-old patient revealed a topographic astigmatism of -11.6 dpt/A 96° 39 months after penetrating keratoplasty. Refractive and keratometric cylinders were each lower (7.25 dpt and 7.0 dpt). Arcuate incisions with segmental augmentation and compression sutures were performed in order to reduce the astigmatism.
Results: After this refractive intervention we saw an intended overdose effect due to the sutures still in situ. This effect accorded to a topographic astigmatism of -11.0 dpt with a changed axis of 163° five months after incision. The refractive cylinder of -4 dpt/A 160° was corrected with spectacles with good acceptance.
Conclusions: With AOPKP a technique is provided to avoid the addition of donor and host corneal astigmatism. Even if secondary surgery in order to reduce astigmatism may lead to rehabilitation in vision it should be asked if penetrating keratoplasty with regard to the astigmatism of donor and host might be a more inexpensive alternative to existing methods.

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