[Severe astigmatism following transfixing keratoplasty: how to attempt to reduce it]

Surgical treatment of astigmatism has been practised since the nineteenth century. Ophthalmologists' attitude has to change with respect to the problem of astigmatism after penetrating keratoplasty. A high astigmatism must no longer be considered as a fatality, particularly in young patients, except in special circumstances to be considered case by case. Rather than waiting for corneal healing, and operating only some time after ablation of the edge-to-edge suture by practising for example a wedge resection, it appears logical to act sooner to benefit from the temporary flexibility of a recent scar. Initially, 5 or 6 very tight sutures should be inserted in the axis of the flatter meridian as a routine procedure. Overcorrection must be as high as the astigmatism to be corrected; the total correction achieved will be reduced by about 50% in the following weeks and will then become stable. The sutures have to be kept in position until the corneal scar is completely healed. Such a method has the drawback of remaining approximate, but this is also the case with other operations proposed at a later stage. It has the advantage of being simple and without risk of lasting overcorrection. This study was essentially a prospective and preliminary one, and analysis of results with more cases will determine whether this method is effective.