Refractive keratoplasty for disabling astigmatism after penetrating keratoplasty

Postoperative astigmatism is one of the major limitations of penetrating keratoplasty. In an attempt to reduce postkeratoplasty astigmatism, we combined corneal-relaxing incisions with orthogonal compression sutures, guided by the intraoperative use of a ring keratometer. Eleven consecutive patients from a mixed referral population with functionally disabling astigmatism were studied. The average preoperative keratometric cylinder of 11.68 diopters was reduced by 7.95 (+/- 3.03 SD) diopters. Each patient's net keratometric cylinder was reduced. We believe that this technique is safer and more predictable than previously published techniques.