Mechanized astigmatic arcuate keratotomy with the Hanna arcitome for astigmatism after keratoplasty

Abstract

Arcuate keratotomy performed with the Hanna arcitome was effective in reducing post-keratoplasty astigmatism. The device enabled safer, easier arcuate incisions than with manual techniques. However, predictability and efficacy could be improved by a more accurate nomogram.

Femtosecond-assisted astigmatic keratotomy for post-keratoplasty irregular astigmatism

“…[3][4][5][6][7] Due to the minimally invasive nature of this technique, it is commonly preferred for PPK astigmatism treatment. [3][4][5][6][7] The technique is similar to limbal relaxing incisions, with the incisions placed inside the donor recipient interface. The major limitations with freehand or mechanical astigmatic incisions are the technical difficulties (especially in PPK patients with irregular, nonorthogonal astigmatism) such as incision predictability that make this technique challenging.…”

“…1,2 Arcuate astigmatic keratotomy (AK) is popular among corneal surgeons since it allows the reduction of high amounts of astigmatism in PPK patients. [3][4][5][6][7][8] Despite that, technical difficulties such as incision uniformity, reproducibility, and predictability are challenging. [5][6][7] We describe the technique of AK using a femtosecond laser in a keratoconic patient with irregular astigmatism 28 years after penetrating keratoplasty (PKP).…”

Management of post-keratoplasty astigmatism

“…58 Various methods of performing AK incisions are currently available. These include freehand techniques, 58,61 mechanical techniques using devices such as the Hanna arcitome, 62 and femtosecond laser ablations. 63,64 Incisions can be placed in the donor graft button, 58 in the host cornea, 65 or in the graft-host junction.…”

Outcomes of femtosecond laser-assisted mushroom-configuration keratoplasty in advanced keratoconus

“…24 By selectively re-opening the anterior lamellar interface of the mushroom-configuration corneal graft, while keeping the lamellar ring and posterior lamellar graft-host interface intact, we believe our modified AMID is safer than Busin's method and than conventional arcuate keratotomy. 25,26 As our technique is unlikely to inadvertently enter the anterior chamber, AMID might also be more predictable as the incision depth is pre-set by the graft construction, and could be applied to other stepped configuration keratoplasty. However, we are aware that further studies with larger cohorts of patients are needed to confirm the advantages of AMID.…”