Post-keratoplasty astigmatism management by relaxing incisions: a systematic review

Yin, G. Ho Wang; Hoffart, L.

doi:10.1186/s40662-017-0093-7

Cited by 35 publications

(30 citation statements)

References 66 publications

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“…There are various methods of reducing suture-related astigmatism. Topography assisted suture rotation, selective suture removal/replacement, placement of compression sutures can help reduce astigmatism in early post-operative period79. In late post-operative period, ablative procedures or arcuate keratotomies can be used.…”

Section: Post-operative Outcomes In Various Types Of Keratoplastymentioning

confidence: 99%

Corneal transplantation in the modern era

et al. 2019

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Corneal blindness is one of the major causes of reversible blindness, which can be managed with transplantation of a healthy donor cornea. It is the most successful organ transplantation in the human body as cornea is devoid of vasculature, minimizing the risk of graft rejection. The first successful transplant was performed by Zirm, and since then, corneal transplantation has seen significant evolution. It has been possible because of the relentless efforts by researchers and the increase in knowledge about corneal anatomy, improvement in instruments and advancements in technology. Keratoplasty has come a long way since the initial surgeries wherein the whole cornea was replaced to the present day where only the selective diseased layer can be replaced. These newer procedures maintain structural integrity and avoid catastrophic complications associated with open globe surgery. Corneal transplantation procedures are broadly classified as full-thickness penetrating keratoplasty and partial lamellar corneal surgeries which include anterior lamellar keratoplasty [sperficial anterior lamellar keratoplasty (SALK), automated lamellar therapeutic keratoplasty (ALTK) and deep anterior lamellar keratoplasty (DALK)] and posterior lamellar keratoplasty [Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK)] broadly.

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Section: Post-operative Outcomes In Various Types Of Keratoplastymentioning

confidence: 99%

Corneal transplantation in the modern era

et al. 2019

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“…FLAK is known for its effectiveness and safety in decreasing corneal astigmatism after a penetrating keratoplasty (PKP) [ 9 , 18 , 26 , 27 , 28 , 29 , 30 , 31 ]. In many cases, one AK is usually effective in decreasing the amount of astigmatism.…”

Section: Introductionmentioning

confidence: 99%

“…In many cases, one AK is usually effective in decreasing the amount of astigmatism. However, residual astigmatism after this procedure is common and may be significant, limiting maximal visual rehabilitation [ 8 , 26 , 27 ]. For patients who undergo a PKP or deep anterior lamellar keratoplasty (DALK), the primary goal of FSAK is to allow the patient to wear contact lenses or spectacles [ 7 , 9 , 32 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

Repeated Femtosecond Laser-Assisted Astigmatic Keratotomies in Post-Keratoplasty Eyes

Levinger

Levinger²,

Erdinest

et al. 2022

JCM

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Visual rehabilitation after a keratoplasty is often compromised due to high amounts of residual astigmatism. Femtosecond laser-assisted astigmatic keratotomy (FLAK) is gaining popularity in decreasing this astigmatism. Though one set of two incisions suffices in most cases, sometimes the treatment proves insufficient and additional treatment is required. This case series evaluates the outcomes in patients who underwent two consecutive FLAK sets to correct post-keratoplasty residual astigmatism. All repeated FLAK cases performed on post-keratoplasty eyes were reviewed in a high-volume clinic as a non-comparative retrospective case series. The data extracted include the procedure parameters, time between procedures, refraction including sphere, astigmatism, spherical equivalent (SE), and uncorrected and best-spectacle-corrected distance visual acuity (UDVA, BSDVA, respectively). Eleven eyes of eleven patients aged 25.5 ± 10 treated with more than one FLAK procedure were identified. The average follow-up time was 6 months after the first FLAK and 24 ± 10 months after the second. The second FLAK was performed six months after the first. The preoperative mean astigmatism was −9.59 ± 2.36 D. At the final follow-up, the mean astigmatism decreased to −5.38 ± 1.79 D (p = 0.001). Repeated FLAK procedures achieved a significant and stable reduction of astigmatism in post-keratoplasty eyes. This procedure shows safety and effectivity in these complex eyes and may prevent the need for a further keratoplasty.

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“…While it is a robust tool, capable of reducing large amounts of astigmatism, its predictability is lower compared with other astigmatism‐correcting procedures (Butrus et al 2007). Therefore, newer AK techniques have been introduced in an effort to improve the procedure’s predictability and safety profile (Ho Wang Yin & Hoffart 2017). The advent of femtosecond laser technology and its incorporation into corneal surgery enables the formation of precise stromal incisions whose depth, length, location and shape can be accurately adjusted.…”

Section: Introductionmentioning

confidence: 99%

Comparison of manual and femtosecond astigmatic keratotomy in the treatment of postkeratoplasty astigmatism

Sorkin

Santaella

Kreimei

et al. 2020

Acta Ophthalmologica

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Purpose To compare the outcomes of femtosecond astigmatic keratotomy (FSAK) and manual astigmatic keratotomy (AK) in treatment of postkeratoplasty astigmatism. Methods A retrospective, comparative, pairwise‐matched case series including 150 patients who underwent either FSAK (n = 75) or manual AK (n = 75) for the treatment of astigmatism (>3.00 D) following penetrating keratoplasty or deep anterior lamellar keratoplasty. Pairwise matching for baseline variables (age, visual acuity and astigmatism) was performed. Results Mean age was 57.5 ± 16.0 years. The FSAK group had significantly better postoperative best‐corrected visual acuity (BCVA) (p = 0.010), uncorrected visual acuity (UCVA) (p = 0.049), corneal astigmatism (p = 0.020) and manifest astigmatism (p < 0.001) compared with the manual AK group. Gain of ≥3 lines in BCVA (logMAR) was seen in five eyes (6.7%) and 21 eyes (28.0%) in manual AK and FSAK, respectively (p = 0.005). Alpins vector analysis showed lower (closer to 0) index of success (0.50 ± 0.24 and 0.79 ± 0.48, p < 0.001) and higher (closer to 1) correction index (0.94 ± 0.45 and 0.74 ± 0.55, p = 0.020) in FSAK compared with manual AK. Corneal and manifest astigmatism improved significantly in both groups, while BCVA and UCVA improved significantly in FSAK only. Repeat AK rate was 32% (24 eyes) in manual AK and 4% (three eyes) in FSAK (p < 0.001). Overcorrection‐related re‐suturing rate was 0% in manual AK and 8% (six eyes) in FSAK (p = 0.037). There was one microperforation (1.3%) in FSAK, and there were no occurrences of graft dehiscence, infectious keratitis or graft rejection. Conclusions Both manual AK and FSAK were safe and effective in reducing postkeratoplasty astigmatism. FSAK had superior visual and keratometric outcomes compared with manual AK.

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Post-keratoplasty astigmatism management by relaxing incisions: a systematic review

Cited by 35 publications

References 66 publications

Corneal transplantation in the modern era

Corneal transplantation in the modern era

Repeated Femtosecond Laser-Assisted Astigmatic Keratotomies in Post-Keratoplasty Eyes

Comparison of manual and femtosecond astigmatic keratotomy in the treatment of postkeratoplasty astigmatism

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