“Blast From The Past, Aks To The Rescue” Case Series Of Manual Arcuate Astigmatic Keratotomies For Post-Keratoplasty Very High Corneal Astigmatism.
Published 2023 - 41st Congress of the ESCRS
Reference: PO0913 | Type: Free paper | DOI: 10.82333/rpkh-p953
Authors: Dimitris Tsigkos* 1 , Sotiria Palioura 2 , Chrysanthi Theodorou 3 , Constantina Gkogkou 3 , Euthumios Zouzoulas 3 , Vasileios Tsigkos 3
1Ophthalmiatreion Athinon,Athens,Greece, 2University of Cyprus,Nicosia,Cyprus, 3Ophthalmological Center C'est La vue,Athens,Greece
Purpose
To highlight the value of manual astigmatic keratotomies (AKs) in the correction of very high corneal astigmatism [> 8 Diopters(D)] after penetrating keratoplasty (PK).
High corneal astigmatism limits the best corrected visual acuity (BCVA) of post-keratoplasty patients and is particularly challenging to manage for the treating physician. Herein, we present 6 patients who experienced significant improvement in BCVA after manual paired AKs on the steep meridian, just anterior to the graft-host junction.
Setting
6 eyes with very high corneal astigmatism (8D, 8.5D,10D,18.5D,12,7D,18D) 2,10,16,19,23 and 45 years after primary PK that negatively impacted BCVA (logMAR range, 1.60 to 0.22). None of the patients were able to tolerate the full correction in their spectacles pre-operatively.
Methods
Manual double paired arcuate AKs (45° with external optic zone 7 mm and internal 6 mm) were performed in all 6 eyes based on Lindstrom’s nomogram modified for corneal grafts.
Appropriate intraoperative adjustments were done, based on intraoperative keratoscopy.
Corticosteroid drops were used before and after the intervention to limit the risk of graft rejection.
Results
Significant reduction in corneal astigmatism was achieved in all 6 eyes (patient #1 5D reduction at 10 months of follow up #2: 7D reduction at 8 months, #3: 7.5D reduction at 6 months , #4: 14D reduction at 6 years #5 5D reduction at 5 months #6: 10D reduction at 5 months).
BCVA improved significantly in all 6 eyes [patient #1 logMAR from 0.4 to 0.3 #2 from 0.3 to 0.1, #3 from 0.5 to 0.3, #4 from 0.22 to 0.1, #5 from 0.5 to 0.4 #6 from 1.6 to 0.5).
There were no intraoperative or postoperative complications. All patients are able to tolerate the full correction in their spectacles until their most recent follow up meeting.
Conclusions
Manual arcuate AKs can still be a useful tool for the experienced corneal surgeon in dealing with demanding cases, such as post-keratoplasty induced high astigmatism.
A significant decrease in intolerable astigmatism can be of high importance for the patient, who can gain functional vision, potentially of high quality, without the use of rigid gas permeable or scleral contact lenses.