Corneal Transplant Relaxing Incisions With An Exceptional Case Of Astigmatism Reduction Of 14 Diopters
Published 2025 - 43rd Congress of the ESCRS
Reference: PO903 | Type: Poster | DOI: 10.82333/ez19-y675
Authors: Ofelya Ginoyan* 1 , Tatevik Harutyunyan 2 , Anna Hovakimyan 3
1Departent of ophthalmology , Cornea-Uveitis department ,YSMU after M.Heratsi , Ophthalmological center after S V Malayan ,Yerevan,Armenia, 2Departent of ophthalmology ,YSMU after M.Heratsi ,Yerevan,Armenia, 3Departent of ophthalmology , Cornea-Uveitis department ,YSMU after M.Heratsi , Ophthalmological center after S.V. Malayan ,Yerevan,Armenia
Purpose
Astigmatism is a leading cause of reduced visual acuity following penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). This study aims to evaluate the effectiveness of graft-host junction relaxing incisions (GHJ RI) in reducing post-keratoplasty astigmatism, optimizing patients’ visual outcomes. Typically, this procedure reduces astigmatism around 3 diopters, making residual refractive error more manageable with spectacles or contact lenses.
Setting
Ophthalmological Center after S.V. Malayan, Cornea-Uveitis Department, Yerevan, Armenia.
Methods
GHJ RIs were performed using a diamond knife, extending the incision to Descemet’s membrane. The study included 18 patients treated over a one-year period (2 DALK, 12 PK, 4 staged PK + phacoemulsification with intraocular lens (IOL) implantation, and 2 combined PK + phaco with IOL implantation, where GHJ RIs were performed intraoperatively). Corneal and lenticular astigmatism were carefully evaluated, with corneal topography guiding incision size and location.
Patients were prescribed antibiotic/steroid eye drops, as well as lubricating eye drops for 2 weeks.
Results
Among the 18 cases, 72% demonstrated a significant reduction in astigmatism (maximum ±9.0D), while 28% had a moderate response. In two cases, initial outcomes were unsatisfactory, necessitating repeat incisions, and in three cases, astigmatism remained largely unchanged. Notably, one exceptional case involved a patient who had undergone PK for keratoconus 30 years prior; following a repeat PK and subsequent GHJ RIs, astigmatism was reduced by an unexpected 14 diopters, improving the visual acuity from 20/500 to 20/80, corrected to 20/30 with spectacles.
In vast majority of cases, 2 weeks later post-procedure the visual acuity dramatically improved, especially with contact lenses or spectacles.
Conclusions
Based on clinical outcomes, GHJ RIs are an effective technique for correcting post-keratoplasty astigmatism. This method offers a practical, time-efficient alternative that does not require an operating room or excimer laser procedure for improvement of vision, making it possible to have satisfactory visual outcome either with spectacles or contact lenses.