Surgical correction of high postkeratoplasty astigmatism. Relaxing incisions vs wedge resection.

Improved techniques and procedures have resulted in a higher rate of clear grafts after penetrating keratoplasty. A clear graft, however, does not give a good visual result if high corneal astigmatism prevents the successful wearing of spectacles or contact lenses. This article describes the methods and results of two microsurgical techniques--the corneal wedge resection to steepen the flat meridian and relaxing incisions to flatten the steep meridian. Average reduction in corneal astigmatism was greater for the wedge resection (ten cases) (6.50 diopters as compared with 4.25 D [16 cases] for the relaxing incisions). The relaxing incisions operation was successful in 75% of cases with stabilization of corneal curvature readings in an average of three weeks and is an outpatient procedure. After a wedge resection, corneal stabilization usually takes months. We believe that wedge resection should be reserved for cases in which relaxing incisions are unsuccessful.