Office-based relaxing incision procedure for correction of astigmatism after deep anterior lamellar keratoplasty

Purpose: to report the outcomes of a simple and effective office-based procedure for the correction of astigmatism after deep anterior lamellar keratoplasty (dalk). methods: this study enrolled 24 consecutive keratoconic eyes that developed an intolerable amount of graft astigmatism after dalk. the location and extension of steep semi-meridians were determined using corneal topography. office-based relaxing incision procedures were performed at the slit-lamp biomicroscope using a 27-gauge needle. relaxing incisions were made at the donor-recipient interface on one side of the steepest meridian with an arc length of 45° to 60° and an initial depth of approximately 70-80% of the corneal thickness. topography was performed after 30-40 minutes and the initial incision was enhanced in depth and length. if an acceptable amount of astigmatism was not achieved,another incision was created at the opposite semi-meridian during the same session. results: mean follow-up period was 13.1 ± 7.4 months. mean preoperative best spectacle corrected visual acuity was 0.26 ± 0.14 logmar,increasing to 0.22 ± 0.09 logmar after the procedure (p = 0.20). mean spherical equivalent refractive error increased from - 4.64 ± 3.06 diopters (d) preoperatively to -6.06 ± 3.15 d postoperatively (p = 0.01). mean keratometric astigmatism was reduced by 2.95 ± 3.43 d and 5.16 ± 2.97 d measured using subtraction and vector analysis methods,respectively (p < 0.001). microperforation occurred in one eye,which spontaneously improved with no sequelae. conclusion: office-based relaxing incision is a safe and effective procedure for the treatment of corneal graft astigmatism after dalk. this approach effectively decreases the need for the more costly alternative in the operating room. © 2017 journal of ophthalmic and vision research published by wolters kluwer - medknow.