Skip to main content
Published Online:https://doi.org/10.3928/1081597X-20190227-01

Abstract

PURPOSE:

To describe 2-year results of deep intrastromal arcuate keratotomy with in situ keratomileusis (DIAKIK) for the treatment of high astigmatism after keratoplasty.

METHODS:

This prospective study included 20 eyes from 20 patients presenting with high astigmatism after keratoplasty. All were treated by two-step femtosecond laser surgery, with two intrastromal arcuate keratotomies and a corneal flap, followed a few months later by excimer photoablation after reopening of the flap.

RESULTS:

At 24 months, both uncorrected (UDVA) and corrected (CDVA) distance visual acuity had improved from 1.12 ± 0.42 logMAR (20/200 Snellen) before surgery to 0.58 ± 0.23 logMAR (20/80 Snellen) (P < .001) and from 0.31 ± 0.26 logMAR (20/40 Snellen) to 0.20 ± 0.20 logMAR (20/32 Snellen) (P = .04), respectively. The mean spherical equivalent improved from −5.01 ± 4.35 to −1.54 ± 2.42 diopters. The mean efficacy index was 0.63. The mean correction index was 0.93 ± 0.32. The mean flattening index was 1.09 ± 0.75 and the mean safety index was 1.39. No graft rejection or epithelial ingrowth was observed.

CONCLUSIONS:

This two-step procedure was an effective treatment for high astigmatism after keratoplasty. The use of both femtosecond and excimer lasers helped to avoid some complications that would have jeopardized the grafts. Refractive and topographic stability was good 2 years after surgery.

[J Refract Surg. 2019;35(4):239–246.]

  • 1.Fares U, Sarhan AR, Dua HS. Management of post-keratoplasty astigmatism. J Cataract Refract Surg. 2012; 38:2029–2039.10.1016/j.jcrs.2012.09.002

    Crossref MedlineGoogle Scholar
  • 2.Burk LL, Waring GO, Radjee B, Stulting RD. The effect of selective suture removal on astigmatism following penetrating keratoplasty. Ophthalmic Surg. 1988; 19:849–854.

    LinkGoogle Scholar
  • 3.Troutman RC. Microsurgical control of corneal astigmatism in cataract and keratoplasty. Trans Am Acad Ophthalmol Otolaryngol. 1973; 77:563–572.

    Google Scholar
  • 4.Roper-Hall MJ, Atkins AD. Control of astigmatism after surgery and trauma: a new technique. Br J Ophthalmol. 1985; 69:352–359.10.1136/bjo.69.5.352

    Crossref MedlineGoogle Scholar
  • 5.Ezra DG, Hay-Smith G, Mearza A, Falcon MG. Corneal wedge excision in the treatment of high astigmatism after penetrating keratoplasty. Cornea. 2007; 26:819–82510.1097/ICO.0b013e318093de39

    Crossref MedlineGoogle Scholar
  • 6.Wilkins MR, Mehta JS, Larkin DFP. Standardized arcuate keratotomy for postkeratoplasty astigmatism. J Cataract Refract Surg. 2005; 31:297–301.10.1016/j.jcrs.2004.07.025

    Crossref MedlineGoogle Scholar
  • 7.Hoffart L, Touzeau O, Borderie V, Laroche L. Mechanized astigmatic arcuate keratotomy with the Hanna arcitome for astigmatism after keratoplasty. J Cataract Refract Surg. 2007; 33:862–868.10.1016/j.jcrs.2007.01.031

    Crossref MedlineGoogle Scholar
  • 8.Feizi S, Javadi MA. Corneal graft curvature change after relaxing incisions for post-penetrating keratoplasty astigmatism. Cornea. 2012; 31:1023–1027.10.1097/ICO.0b013e31823f8db9

    Crossref MedlineGoogle Scholar
  • 9.Viswanathan D, Kumar NL. Bilateral femtosecond laser-enabled intrastromal astigmatic keratotomy to correct high post-penetrating keratoplasty astigmatism. J Cataract Refract Surg. 2013; 39:1916–1920.10.1016/j.jcrs.2013.08.019

    Crossref MedlineGoogle Scholar
  • 10.Fares U, Mokashi AA, Al-Aqaba MA, Otri AM, Miri A, Dua HS. Management of postkeratoplasty astigmatism by paired arcuate incisions with compression sutures. Br J Ophthalmol. 2013; 97:438–443.10.1136/bjophthalmol-2012-302128

    Crossref MedlineGoogle Scholar
  • 11.Nubile M, Carpineto P, Lanzini M, et al.Femtosecond laser arcuate keratotomy for the correction of high astigmatism after keratoplasty. Ophthalmology. 2009; 116:1083–1092.10.1016/j.ophtha.2009.01.013

    Crossref MedlineGoogle Scholar
  • 12.Rückl T, Dexl AK, Bachernegg A, et al.Femtosecond laser-assisted intrastromal arcuate keratotomy to reduce corneal astigmatism. J Cataract Refract Surg. 2013; 39:528–538.10.1016/j.jcrs.2012.10.043

    Crossref MedlineGoogle Scholar
  • 13.Al Sabaani N, Al Malki S, Al Jindan M, Al Assiri A, Al Swailem S. Femtosecond astigmatic keratotomy for postkeratoplasty astigmatism. Saudi J Ophthalmol. 2016; 30:163–168.10.1016/j.sjopt.2016.04.003

    Crossref MedlineGoogle Scholar
  • 14.Busin M, Arffa RC, Zambianchi L, Lamberti G, Sebastiani A. Effect of hinged lamellar keratotomy on postkeratoplasty eyes. Ophthalmology. 2001; 108:1845–1851.10.1016/S0161-6420(01)00702-3

    Crossref MedlineGoogle Scholar
  • 15.Alió JL, Javaloy J, Osman AA, Galvis V, Tello A, Haroun HE. Laser in situ keratomileusis to correct post-keratoplasty astigmatism; 1-step versus 2-step procedure. J Cataract Refract Surg. 2004; 30:2303–2310.

    Crossref MedlineGoogle Scholar
  • 16.Güell JL, Vazquez M. Correction of high astigmatism with astigmatic keratotomy combined with laser in situ keratomileusis. J Cataract Refract Surg. 2000; 26:960–966.10.1016/S0886-3350(00)00406-5

    Crossref MedlineGoogle Scholar
  • 17.Bahar I, Kaiserman I, Mashor RS, McAllum P, Slomovic A, Rootman D. Femtosecond LASIK combined with astigmatic keratotomy for the correction of refractive errors after penetrating keratoplasty. Ophthalmic Surg Lasers Imaging. 2010; 41:242–249.10.3928/15428877-20100303-14

    LinkGoogle Scholar
  • 18.Hanna KD, Hayward JM, Hagen KB, Simon G, Parel JM, Waring GO. Keratotomy for astigmatism using an arcuate keratome. Arch Ophthalmol. 1993; 111:998–1004.10.1001/archopht.1993.01090070118030

    Crossref MedlineGoogle Scholar
  • 19.Alpins NA. A new method of analyzing vectors for changes in astigmatism. J Cataract Refract Surg. 1993; 19:524–533.10.1016/S0886-3350(13)80617-7

    Crossref MedlineGoogle Scholar
  • 20.Alpins NA. Vector analysis of astigmatism changes by flattening, steepening, and torque. J Cataract Refract Surg. 1997; 23:1503–1514.10.1016/S0886-3350(97)80021-1

    Crossref MedlineGoogle Scholar
  • 21.Loriaut P, Sandali O, El Sanharawi M, Goemaere I, Borderie V, Laroche L. New combined technique of deep intrastromal arcuate keratotomy overlayed by LASIK flap for treatment of high astigmatism. Cornea. 2014; 33:1123–1128.10.1097/ICO.0000000000000236

    Crossref MedlineGoogle Scholar
  • 22.Shalash RB, Elshazly MI, Salama MM. Combined intrastromal astigmatic keratotomy and laser in situ keratomileusis flap followed by photoablation to correct post-penetrating keratoplasty ametropia and high astigmatism: one-year follow-up. J Cataract Refract Surg. 2015; 41:2251–2257.10.1016/j.jcrs.2015.10.028

    Crossref MedlineGoogle Scholar
  • 23.Alio Del Barrio JL, Tiveron M, Plaza-Puche AB, et al.Laser-assisted in situ keratomileusis with optimized, fast-repetition, and cyclotorsion control excimer laser to treat hyperopic astigmatism with high cylinder. Eur J Ophthalmol. 2017; 18:686–693.10.5301/ejo.5001051

    CrossrefGoogle Scholar
  • 24.Bilgihan K, Ozdek SC, Akata F, Hasanreisoglu B. Photorefractive keratectomy for post-penetrating keratoplasty myopia and astigmatism. J Cataract Refract Surg. 2000; 26:1590–1595.10.1016/S0886-3350(00)00692-1

    Crossref MedlineGoogle Scholar
  • 25.Bahar I, Levinger E, Kaiserman I, Sansanayudh W, Rootman DS. IntraLase-enabled astigmatic keratotomy for post keratoplasty astigmatism. Am J Ophthalmol. 2008; 146:897–904.10.1016/j.ajo.2008.07.004

    Crossref MedlineGoogle Scholar
  • 26.Kumar NL, Kaiserman I, Shehadeh-Mashor R, Sansanayudh W, Ritenour R, Rootman DS. IntraLase-enabled astigmatic keratotomy for post-keratoplasty astigmatism: on-axis vector analysis. Ophthalmology. 2010; 117:1228–1235.10.1016/j.ophtha.2009.10.041

    Crossref MedlineGoogle Scholar
  • 27.Böhringer D, Dineva N, Maier P, et al.Long-term follow-up of astigmatic keratotomy for corneal astigmatism after penetrating keratoplasty. Acta Ophthalmol. 2016; 94:607–611.10.1111/aos.13061

    CrossrefGoogle Scholar
  • 28.Lockington D, Wang EF, Patel DV, Moore SP, McGhee CN. Effectiveness of cataract phacoemulsification with toric intraocular lenses in addressing astigmatism after keratoplasty. J Cataract Refract Surg. 2014; 40:2044–2049.10.1016/j.jcrs.2014.03.025

    Crossref MedlineGoogle Scholar
  • 29.Tahzib NG, Cheng YY, Nuijts RM. Three-year follow-up analysis of Artisan toric lens implantation for correction of postkeratoplasty ametropia in phakic and pseudophakic eyes. Ophthalmology. 2006; 113:976–984.10.1016/j.ophtha.2006.02.025

    Crossref MedlineGoogle Scholar
  • 30.Coskunseven E, Kavadarli I, Sahin O, Kayhan B, Pallikaris I. Refractive outcomes of 20 eyes undergoing ICL implantation for correction of hyperopic astigmatism. J Refract Surg. 2017; 33:604–609.10.3928/1081597X-20170504-06

    LinkGoogle Scholar
  • 31.Sari ES, Pinero DP, Kubaloglu A, et al.Toric implantable collamer lens for moderate to high myopic astigmatism: 3-year follow-up. Graefes Arch Clin Exp Ophthalmol. 2013; 251:1413–1422.10.1007/s00417-012-2172-8

    Crossref MedlineGoogle Scholar
  • 32.Mrochen M, Krueger RR, Bueeler M, Seiler T. Aberration-sensing and wavefront-guided laser in situ keratomileusis: management of decentered ablation. J Refract Surg. 2002; 18:418–429.

    LinkGoogle Scholar
  • 33.Laíns I, Rosa AM, Guerra M, et al.Irregular astigmatism after corneal transplantation-efficacy and safety of topography-guided treatment. Cornea. 2016; 35:30–36.10.1097/ICO.0000000000000647

    Crossref MedlineGoogle Scholar

We use cookies on this site to enhance your user experience. For a complete overview of all the cookies used, please see our privacy policy.

×