Abstract
PURPOSE: To report the outcomes of a simple and effective office-based procedure for the correction of astigmatism after deep anterior lamellar keratoplasty (DALK). METHODS: This study enrolled 24 consecutive keratoconic eyes that developed an intolerable amount of graft astigmatism after DALK. The location and extension of steep semi-meridians were determined using corneal topography. Office-based relaxing incision procedures were performed at the slit-lamp biomicroscope using a 27-gauge needle. Relaxing incisions were made at the donor-recipient interface on one side of the steepest meridian with an arc length of 45° to 60° and an initial depth of approximately 70-80% of the corneal thickness. Topography was performed after 30-40 minutes and the initial incision was enhanced in depth and length. If an acceptable amount of astigmatism was not achieved, another incision was created at the opposite semi-meridian during the same session. RESULTS: Mean follow-up period was 13.1 ± 7.4 months. Mean preoperative best spectacle corrected visual acuity was 0.26 ± 0.14 logMAR, increasing to 0.22 ± 0.09 logMAR after the procedure (P = 0.20). Mean spherical equivalent refractive error increased from - 4.64 ± 3.06 diopters (D) preoperatively to -6.06 ± 3.15 D postoperatively (P = 0.01). Mean keratometric astigmatism was reduced by 2.95 ± 3.43 D and 5.16 ± 2.97 D measured using subtraction and vector analysis methods, respectively (P < 0.001). Microperforation occurred in one eye, which spontaneously improved with no sequelae. CONCLUSION: Office-based relaxing incision is a safe and effective procedure for the treatment of corneal graft astigmatism after DALK. This approach effectively decreases the need for the more costly alternative in the operating room.