1. Surgical Management Of Giant Astigmatism After Penetrating Keratoplasty
O Beltaief, Kh Errais, W Zbiba, A Ouertani.
Charles Nicolle University Hospital - Tunis- Tunisia
Authors have no financial interest

2. INTRODUCTION
Giant astigmatism can dramatically reduce final visual acuity and graft success in penetrating keratoplasty despite clear graft and absence of anatomic complications.
Corneal surgery as relaxing incision or wedge resection could be used to reduce postoperative astigmatism.

3. PATIENTS & METHODS Retrospective, nonrandomized, case series.
15 patients were operated on from 2002 to 2007.
Postoperative astigmatism was superior to 5 diopters in all cases with an average of 7.3 D (ranging from 5 to 11D).
Incision surgery was:
wedge resection in 8 cases
relaxing arcuate incision in 6 cases
both in 1case.
Mean follow up was 9 months.

4. REFRACTIVE RESULTS Preoperative visual acuity was 0.38 +/- 0.18
Postoperative VA increased to /-0.14 (ranging from 0.3 to 0.9)
Visual acuity was increased in 12 cases (80%) and reduced in 2 cases (13.4%).

5. REFRACTIVE RESULTS Initial astigmatism: 7.3+/- 1.1 D
Post-op astigmatism was reduced to 4.5 +/-2.4 D (ranging from 1 to 7.4D)
Astigmatism decrease average : 2.8 D
Sphere increased from -4.5 D to -7.5D.

6. RESULTS Wedge ResectionWR
4 years after WR
Cyl: 1.58D;
VA= 20/25 (-6D)
Cyl = 11D
VA= 20/60
K1: / K2:38.17
1 year after WR

7. RESULTS Wedge Resection
Pre-op VA: 20/60
Post-op VA: 20/30

8. ANATOMIC RESULTS
Rejection occurred in 1 patients and was controlled by loco-regional treatment
Loose sutures in 2 patients
Infectious ulcer in 1 patient
All grafts remained clear

9. CONCLUSIONS
Incisional corneal surgery can improve high astigmatism and visual acuity after keratoplasty and prevent regrafting.
Incisional techniques could become more predictable with femtosecond laser.