Management Of Post-Keratoplasty Astigmatism Using A Topography-Guided Approach By Reopening And Resuturing.

The purpose of this case study is to demonstrate the management of post-keratoplasty astigmatism using a topography-guided approach by reopening and resuturing.

Prof. Dr. Hazem Yassin Ophthalmology centers

45-year-old female with a diagnosis of advanced keratoconus DALK (deep anterior lamellar keratoplasty ) was done 2 years ago. She came to our clinic with visual acuity 0.05 with autorefraction +2.00/ -12.50 * 125 , her BCVA by -10.00 cylider power axis 125 was 0.5. Corneal topography was done revealed significant astigmatism with a cylinder of -9.9 diopters ,  46.00 diopters on the steepest meridian, while the flat meridian showed a 36 diopters curvature. 

Decision was taken to reopen conreal graft junction partial thickness 90% at steep and flat meridians then resuturing by loose sutures at steep meridian and tight sutures at flat one .

Postoperatively, the patient’s visual acuity improved; with visual acuity 0.5 with autorefraction +0.50/ -3.75 * 125 , her BCVA by -3.75 cylider power axis 125 was 0.5. Corneal topography was done revealed cylinder of -4.1 diopters , 47.5 diopters on the steepest meridian, while the flat meridian showed a 43.5 diopters curvature. 

Six months later , uncorrected visual acuity is 0.5 with autorefration +0.50 / -2.50* 130 with improvement by this correction to 0.6 .Descision was taken to remove the sutures .

This case illustrates that topography-guided reopening and resuturing is a highly effective technique for managing persistent astigmatism following keratoplasty.