1. Late wound revision for post PKP high astigmatism or ectasia
Lilia Rivera, MD
San Juan, P.R.
No financial interests to disclose

2. Methods
A retrospective review of 23 charts of 22 patients( patient SO had both eyes done) who had undergone wound revision of a Penetrating Keratoplasty for high postoperative astigmatism or ectasia.
Data was divided on eyes that had all sutures removed with at least 12 month follow up post suture removal and eyes that had still some sutures in at 12 month follow up

3. Surgical Technique Under retrobulbar block for anesthesia
The epithelium is scrapped with a spatula in the wound area
A surgical keratoscope is used to identify the flat axis
The wound is opened with a blade and pulling, in some cases the wound will give up easily but in most cases as most of the graft were many years old the wound will then be open by scissors

4. Surgical Technique
Hydroxypropyl methylcellulose solution will be applied to keep the A/C, the wound will be opened either 360 degrees alternating suture placement, or 2 quadrants of penetrating opening at the flat axis with partial opening at the other 2 steep quadrants according to refractive error
On average 16 interrupted 10-0 nylon sutures will be placed
Sutures adjustment with the keratoscope at end to obtain some reversal of the astigmatic axis

5. Results
Of the 23 eyes revised 2 had localized edema that resolved and one had persistant corneal edema (data of this patient not included as K’s not reliable, this was a Fuch’s patient 78 yrs old)
Of the 13 eyes that had all the sutures removed for more than 12 months the average pre WR astigmatism decreased from 9.75 D to 4.72, the average preop BSCVA went from 20/200 to 20/40, the BSCVA improved in all these eyes except 2 were it remained the same

6. Results
In one eye (XL) the astigmatism increased from 4D to 7, in this patient WR was done for anisommetropia. The BSCVA pre and post was 20/30, the spherical equivalent decreased from to -1.50
In one eye (BL)the astigmatism returned to the same level 8D with BSCVA remaining the same 20/50

7. Table 1 Patient Age and Sex Reason for PKP Time PKP -WR WR sut out
Time FU WR
Mean preop K
Mean post K LC
46 F KC
105 m
21m
36m 45
43.25 AB
71F
252m 8m
149m
49.5 XL
35M
43m
31m
83m
48.25 WM
48M
10m
77m
43.5 GC
29F
119m
11m
37m
50.25
49.25 SR
46F
156m
38m
40m 44
40.75 AC
75M
Fuch
14m
42m 53
43.75 WB
40M
26m
35m 47 CF
41F
148m
18m 43 42
168m
41m
56m 49
43.50 SO
43F
13m
32m 51
47.50 WE
47M
180m
12m
27m
50.50 41 BL
141m
30m 46

8. Change in Astigmatism all sutures out Chart 1

9. BSCVA change all sutures out Chart 2

10. Patients with still some sutures inPt
Age-sex DX
PKP-WR
Mean K pre WR
Mean K
Post WR
FU WR
Astig pre WR
Ast post WR LM
37F KC
224m
52.50
42.50
12m
15D 4D MR
78F BK
38m 48 41
34m 6D 5D MG
61F
Scar
42m
46.50 43
33m 8D 2D IP
75F
41m 54
45.75
36m
10D 3D SO
43F
144m 50
19m SD
41F
180m
44.5
44.75
46m 7D
1.5D CR
54F
168m 52 44
16m
9.5D
4.25D AC
50F
198m 42
26D JR
44M
40.75
1.75D

11. Pentacam comparison

12. Conclusion
Late wound revision is a safe alternative for high astigmatism or ectasia correction in patients that otherwise would have to have another graft done as they were unable to be corrected visually adequately either with glasses or contact lenses, adding years of useful vision to grafts several years old.