Femtosecond-laser arcuate wedge-shaped resection to correct high residual astigmatism after penetrating keratoplasty.

We describe a standardized technique of femtosecond (FS) laser arcuate resection (LAR) in which intersecting arcuate cuts are used to perform a wedge resection for the correction of high astigmatism. A simple formula was used to calculate the relative decentration of the arcuate cuts based on the radii of curvature and desired wedge width to be resected. Feasibility of the procedure was established in porcine corneas before treatment of a patient with 20 diopters (D) of post-keratoplasty astigmatism. The astigmatism was reversed. Suture removal resulted in reduction of 14.5 D of astigmatism. Laser arcuate resection can be an effective alternative to manual wedge resection, allowing easier, more controlled, and more precise excision of tissue in width, length, and depth.