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Aim: We examined the effectiveness of arcuate incisions by femtosecond laser treatment for high astigmatism in corneal transplants., Background: High astigmatism is a well known complication after corneal transplantation and is difficult to treat. At present, there are many surgical procedures for the correction of high astigmatism after PKP in case of an unsuccessful contact lens therapy., Patients and Methods: Ten patients with a high postoperative astigmatism underwent arcuate keratotomy with the Femtec laser. We performed two arcuate incisions on each transplant. With the femtosecond laser technology it is possible to perform precise incisions where the depth and length of the arcus can be programmed., Results: The best corrected visual acuity was improved in eight out of ten patients. The visual acuity of two patients did not change. The average corneal astigmatism was reduced by three dioptres. The average refractive astigmatism was reduced by four dioptres., Conclusion: Arcuate incisions with the femtosecond laser on patients with high astigmatism subsequent to corneal transplantation are an effective and safe treatment.

Background: High postkeratoplasty astigmatism remains a challenge for the surgeon. First experiences after implantation of a toric PMMA IOL in three eyes from patients with cataracts are reported., Materials and Methods: After routine phacoemulsification we implanted an individually manufactured toric PMMA posterior chamber IOL via a sclerocorneal 6-mm tunnel incision in three postkeratoplasty eyes with high, topographically relatively regular astigmatism. One eye with the intraoperative aspect of circular zonular instability also received a capsular tension ring. A complete standard ocular examination was performed pre- and postoperatively including corneal topography, evaluation of anterior chamber depth, ultrasonic biomicroscopy and perimetry., Results: Implantation and intraoperative alignment of the toric IOL were uneventful. The refractive astigmatisms of 5.0, 6.0 and 7.5 cyl D preoperatively, were reduced to 2.0, 1.75 and 3.0 cyl D, 10 and 12 months postoperation, respectively. The eye with the capsular tension ring showed no morphological or refractive changes during follow-up. In the other two eyes we observed IOL rotation of 20 and 30, respectively after 6 months. There were no posterior capsule opacification or capsular folds in the optical centre., Conclusion: Toric IOL technology allows enhancement of IOL surgery with improved refractive outcome. Simultaneous implantation of a capsular tension ring may improve long-term stability.

Purpose: To assess the effectiveness of excimer laser correction of high astigmatism after keratoplasty., Setting: Kiel University Eye Hospital, Kiel, Germany., Methods: In a prospective study, we treated high astigmatism in 16 patients using a 193 nm excimer laser with a rotating mask system to make a toric ablation. Thirteen patients had postkeratoplasty astigmatism, 3, idiopathic natural astigmatism. Preoperative refractive cylinder ranged from 3.0 to 9.0 diopters (D). Minimum follow-up was 6 months., Results: Mean uncorrected visual acuity increased by 3.3 lines in 13 patients. Best corrected visual acuity decreased by no more than two lines in 6 patients and improved by at least one line in 6 patients. Mean cylindrical reduction was 2.8 D. Haze was classified from 0.5 to 2.0., Conclusions: In this study, the excimer laser technique effectively reduced high corneal astigmatism. The main problems incurred were development of a hyperopic shift and, in some patients, an uncertain refractive outcome. Reasons for inadequate correction of postkeratoplasty astigmatism included a slightly decentered mask and irregular astigmatism from the circular scar.