Wedge Resection Of The Cornea For The Management Of High Astigmatism Due To Corneal Scarring Following Keratoplasty And Bacterial Keratitis

Wedge resection of the cornea is successfully used in advanced pellucid marginal degeneration patients. Here, we describe an alternative use this technique for the management of high astigmatism in a patient who developed corneal abscess and subsequent corneal scarring following penetrating keratoplasty (PKP).

Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalçın City Hospital, Ophthalmology Clinic. 

A 53-year-old female patient presented with corneal abscess at the first postoperative week following PKP. The patient was first treated with topical antibiotics and later with amniotic membrane transplantation for the management of corneal melting. The patient responded well to the treatment, but developed high astigmatism after the resolution of the infection due to corneal scarring.

Upon examination, while the right eye examination was unremarkable except for intermediate keratoconus, the left eye showed corneal vascularization and scarring in the inferior quadrant, with a visual acuity of 0.5 OD and counting fingers at 1 meter OS. Corneal topography revealed steepening at the inferotemporal area (K-max and high irregular astigmatism (-8.52D @120). The optical axis of the corneal graft was clear. We wanted to keep the graft, removed the keratoplasty sutures, did a wedge resection to the inferotemporal site of the graft tissue and resutured the graft cornea. The irregular astigmatism reduced to -5.01 @62. In addition, the visual acuity of left eye improved to 0.3.

This case demonstrates the effectiveness of wedge resection of the cornea as a valuable technique for managing high astigmatism resulting from corneal scarring after penetrating keratoplasty and bacterial keratitis. In our patient with corneal scarring and significant astigmatism post-PKP, wedge resection at the inferotemporal site of the graft led to a notable reduction in irregular astigmatism and improvement in visual acuity. This approach preserved the corneal graft and improved the patient's visual outcome, highlighting its potential as a viable option in similar cases where traditional methods may not be sufficient.