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Extreme post penetrating keratoplasty astigmatism due to incomplete decentered trephination and management with prolene sutures

Poster Details

First Author: Z.Ozbek TURKEY

Co Author(s):    I. Durak                    

Abstract Details

Purpose:

To report and discuss a case with 23D of astigmatism due to incomplete decentered trephination during penetrating keratoplasty (PK)which was managed with additional separate prolene sutures.

Setting:

Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey.

Methods:

A 76-year-old lady underwent a PK for central scar due to bacterial keratitis OD in August 2013. Visual acuity was 0.1 at the first postoperative week with 7D of keratometric astigmatism. However the keratometric and topographic astigmatism increased to 15D at the first month and reached up to -23Dx180 in 3 months. Careful examination of the nasal recipient tissue at the slit-lamp revealed a cresentric stromal cut due to intraoperative incomplete decentered trephination. After obtaining informed consent 5 separate 10/0 prolene sutures were passed through the donor to the recipient bridging and apposing the cresentric cut in December 2013.

Results:

The resultant keratometric and topographic astigmatism was 11Dx90 at the first postoperative month with a corrected visual acuity of 0.2. By the end of six months visual acuity improved to 0.3 and the ketaometric astigmatism was -6.00x60.

Conclusions:

Instrument jams and misalignments can occur during PK and lead to an unpleasant postoperative surprise. Surgeon’s experience can provide a conventional but extremely effective solution. Financial disclosure: none

Financial Disclosure:

NONE

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