Wedge resection in host cornea to correct post-keratoplasty astigmatism

The obvious problem with surgery of this nature is that the amount of wedge to be removed is partially guess work. Doctor Troutman's keratoscope attachment to his microscope is very helpful. I have tried thermokeratoplasty in a very similar case, but the disadvantages of pain, ulceration, vascularization, and considerable return to pre-burn K readings have made me abandon this technique. If there is an obvious override, then the keratoplasty wound itself must be revised in the usual manner. However, for the present, when a graft looks perfect but the K readings reveal otherwise, a judicious wedge resection between graft and limbus (location being in the flattest meridian) would appear to be a most reasonable operation.