Official ESCRS | European Society of Cataract & Refractive Surgeons


Management of high astigmatism after penetrating keratoplasty by means of penetrating relaxing incisions under a flap

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Session Details

Session Title: Cornea Surgical: Keratoplasties

Session Date/Time: Monday 16/09/2019 | 16:30-18:00

Paper Time: 17:36

Venue: Free Paper Forum: Podium 1

First Author: : E.Melardi ITALY

Co Author(s): :    A. Friehmann   J. Myerscough   C. Bovone   M. Busin                    

Abstract Details


To describe a surgical technique of penetrating relaxing incisions performed under a flap (PRIUF), and its associated outcomes in the management of high astigmatism following penetrating keratoplasty (PK)


All surgical procedures were performed at a single tertiary referral center Forli, Italy. Prospective study, all patients undergoing PRIUF since 2003 with a minimal follow up of 14 months were included.


Sixteen eyes of 16 patients with high astigmatism after PK undergoing PRIUF, with at least 1 year of follow up were included. Eyes with abnormal PK wounds, such as those with high astigmatism secondary to keratoconus recurrence were excluded. In all cases, a 200 microkeratome head was used to create a hinged corneal flap, with 2 full thickness incisions centered on the steep axes and made through the original PK wound or immediately inside of it. The flap was replaced and secured using a double running 10-0 nylon suture which was removed 2-3 months postoperatively.


There were no intraoperative complications. At the final follow-up examination, keratometric astigmatism (mean±SD) decreased from 7.2±2.6 diopters (D) preoperatively to 3.4±1.9 D (p<0.001) and the proportion of eyes with high astigmatism (≥ 4.5D) was 18% in contrast to 74% before PRIUF (p<0.001); BSCVA (mean±SD) improved from 0.43±0.27 preoperatively to 0.80± 0.29 (p<0.001), with no patients requiring to wear contact lenses to correct the residual astigmatism. During a follow-up (mean±SD) of 3.9±2.6 years, no immunologic rejection episodes nor graft failure were seen, and no patients required additional intervention for astigmatic correction


In conclusion, PRIUF reduces post-PK astigmatism to stable values compatible with spectacle correction, in the absence of vision-threatening complications.

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