eMedicine Specialties > Ophthalmology > Refractive Disorders

Astigmatism, Astigmatic Keratotomy: Multimedia

Author: James Hays, MD, Consulting Staff, Department of Corneal Transplantation and Refractive Surgery, Atlanta Eye Surgery Center
Coauthor(s): Spencer Thornton, MD, Medical Director, Thornton Eye Center; Antonio Pascotto, MD, Consulting Ophthalmologist, Pascotto, Istituto per la Salute degli Occhi, Clinica Mediterranea, Italy; Sergio Claudio Saccà, PhD, Professor of Ophthalmology, Department of Neurological and Visual Sciences, Ospedale San Martino, Italy; Mauro Fioretto, MD, Professor of Ophthalmology, University Eye Clinic of Genova; Head of Ophthalmology Department, Hospital of Casale Monferrato, Italy; Vincenzo Orfeo, MD, Head, Operating Unit, Clinica Mediterranea, Naples, Italy
Contributor Information and Disclosures

Updated: Oct 21, 2009

Multimedia

Thornton astigmatic keratotomy ruler.
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Media file 1: Thornton astigmatic keratotomy ruler.
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Thornton astigmatic keratotomy ruler.

Thornton astigmatic keratotomy ruler.

Close-up view of Thornton astigmatic keratotomy r...
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Media file 2: Close-up view of Thornton astigmatic keratotomy ruler.
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Close-up view of Thornton astigmatic keratotomy r...

Close-up view of Thornton astigmatic keratotomy ruler.

Example 1. Routine astigmatic keratotomy. In thi...
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Media file 3: Example 1. Routine astigmatic keratotomy. In this image, a nasal astigmatic keratotomy is shown. This image was taken minutes after performing the incision. Note that the area around the cut stains lightly with fluorescein.
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Example 1. Routine astigmatic keratotomy. In thi...

Example 1. Routine astigmatic keratotomy. In this image, a nasal astigmatic keratotomy is shown. This image was taken minutes after performing the incision. Note that the area around the cut stains lightly with fluorescein.

Example 2. Routine astigmatic keratotomy followin...
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Media file 4: Example 2. Routine astigmatic keratotomy following corneal transplant. This 30-year-old woman underwent corneal transplantation for keratoconus 6 years ago. She presented with a clear graft but with excessive astigmatism. Based on topography, an incision was placed just inside the donor-recipient interface from 250° to 300°. A second incision was placed between 30° and 70°. Refraction improved from +0.75 + 3.00 X 58° to +0.50 + 1.50 X 130°. Best-corrected vision remained 20/20. Note the precise flattening in the topographical map exactly at the axis of the incisions. Incisions were not paired at 180° apart, but they were localized precisely on the basis of topography. This photo is the preastigmatic keratotomy topography.
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Example 2. Routine astigmatic keratotomy followin...

Example 2. Routine astigmatic keratotomy following corneal transplant. This 30-year-old woman underwent corneal transplantation for keratoconus 6 years ago. She presented with a clear graft but with excessive astigmatism. Based on topography, an incision was placed just inside the donor-recipient interface from 250° to 300°. A second incision was placed between 30° and 70°. Refraction improved from +0.75 + 3.00 X 58° to +0.50 + 1.50 X 130°. Best-corrected vision remained 20/20. Note the precise flattening in the topographical map exactly at the axis of the incisions. Incisions were not paired at 180° apart, but they were localized precisely on the basis of topography. This photo is the preastigmatic keratotomy topography.

Postoperative topography following astigmatic ker...
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Media file 5: Postoperative topography following astigmatic keratotomy for case described in Media file 4 of a 30-year-old woman with penetrating keratoplasty for keratoconus.
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Postoperative topography following astigmatic ker...

Postoperative topography following astigmatic keratotomy for case described in Media file 4 of a 30-year-old woman with penetrating keratoplasty for keratoconus.

Example 3. Astigmatic keratotomy with corneal tra...
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Media file 6: Example 3. Astigmatic keratotomy with corneal transplant. This patient underwent corneal transplantation for Fuchs dystrophy. After all sutures were removed, she had approximately 6.5 diopters of keratometric astigmatism. The sutures seemed to be tighter temporally than nasally. She underwent astigmatic keratotomy with a 50° incision temporally and a 30° incision nasally. Residual astigmatism was slightly less than a diopter. This much astigmatism alteration, 5.5 diopters, from a total of 80° of relaxing incision in normal corneas is not expected. Posttransplant corneas are variable, and individual results can vary widely. Monitor the results as best as possible intraoperatively and be willing to go back and suture an overcorrection if it should appear. Topography shows preoperative and postoperative readings with differential.
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Example 3. Astigmatic keratotomy with corneal tra...

Example 3. Astigmatic keratotomy with corneal transplant. This patient underwent corneal transplantation for Fuchs dystrophy. After all sutures were removed, she had approximately 6.5 diopters of keratometric astigmatism. The sutures seemed to be tighter temporally than nasally. She underwent astigmatic keratotomy with a 50° incision temporally and a 30° incision nasally. Residual astigmatism was slightly less than a diopter. This much astigmatism alteration, 5.5 diopters, from a total of 80° of relaxing incision in normal corneas is not expected. Posttransplant corneas are variable, and individual results can vary widely. Monitor the results as best as possible intraoperatively and be willing to go back and suture an overcorrection if it should appear. Topography shows preoperative and postoperative readings with differential.

More on Astigmatism, Astigmatic Keratotomy

Overview: Astigmatism, Astigmatic Keratotomy
Workup: Astigmatism, Astigmatic Keratotomy
Treatment: Astigmatism, Astigmatic Keratotomy
Multimedia: Astigmatism, Astigmatic Keratotomy
References
Further Reading
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References

  1. Thornton SP, Sanders DR. Graded nonintersecting transverse incisions for correction of idiopathic astigmatism. J Cataract Refract Surg. Jan 1987;13(1):27-31. [Medline].

  2. Buzard K, Haight D, Troutman R. Ruiz procedure for postkeratoplasty astigmatism. J Refractive Surgery. 1987;3:40-5.

  3. Price FW, Grene RB, Marks RG, Gonzales JS. Astigmatism reduction clinical trial: a multicenter prospective evaluation of the predictability of arcuate keratotomy. Evaluation of surgical nomogram predictability. ARC-T Study Group. Arch Ophthalmol. Mar 1995;113(3):277-82. [Medline].

  4. Nordan LT. Quantifiable astigmatism correction: concepts and suggestions, 1986. J Cataract Refract Surg. Sep 1986;12(5):507-18. [Medline].

  5. Lindstrom RL. The surgical correction of astigmatism: a clinician's perspective. Refract Corneal Surg. Nov-Dec 1990;6(6):441-54. [Medline].

  6. Troutman RC, Swinger C. Relaxing incision for control of postoperative astigmatism following keratoplasty. Ophthalmic Surg. Feb 1980;11(2):117-20. [Medline].

  7. Krumeich JH, Kezirian GM. Circular keratotomy to reduce astigmatism and improve vision in stage I and II keratoconus. J Refract Surg. Apr 2009;25(4):357-65. [Medline].

  8. Hoffart L, Proust H, Matonti F, Conrath J, Ridings B. Correction of postkeratoplasty astigmatism by femtosecond laser compared with mechanized astigmatic keratotomy. Am J Ophthalmol. May 2009;147(5):779-87, 787.e1. [Medline].

  9. Navarro R, Palos F, Lanchares E, Calvo B, Cristobal JA. Lower- and higher-order aberrations predicted by an optomechanical model of arcuate keratotomy for astigmatism. J Cataract Refract Surg. Jan 2009;35(1):158-65. [Medline].

  10. Kymionis GD, Yoo SH, Ide T, Culbertson WW. Femtosecond-assisted astigmatic keratotomy for post-keratoplasty irregular astigmatism. J Cataract Refract Surg. Jan 2009;35(1):11-3. [Medline].

  11. Bahar I, Levinger E, Kaiserman I, Sansanayudh W, Rootman DS. IntraLase-enabled astigmatic keratotomy for postkeratoplasty astigmatism. Am J Ophthalmol. Dec 2008;146(6):897-904.e1. [Medline].

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Keywords

astigmatism, astigmatic keratotomy, AK, arcuate keratotomy, transverse keratotomy, refractive surgery

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Contributor Information and Disclosures

Author

James Hays, MD, Consulting Staff, Department of Corneal Transplantation and Refractive Surgery, Atlanta Eye Surgery Center
Disclosure: Nothing to disclose.

Coauthor(s)

Spencer Thornton, MD, Medical Director, Thornton Eye Center
Spencer Thornton, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Surgeons
Disclosure: Nothing to disclose.

Antonio Pascotto, MD, Consulting Ophthalmologist, Pascotto, Istituto per la Salute degli Occhi, Clinica Mediterranea, Italy
Disclosure: Nothing to disclose.

Sergio Claudio Saccà, PhD, Professor of Ophthalmology, Department of Neurological and Visual Sciences, Ospedale San Martino, Italy
Disclosure: Nothing to disclose.

Mauro Fioretto, MD, Professor of Ophthalmology, University Eye Clinic of Genova; Head of Ophthalmology Department, Hospital of Casale Monferrato, Italy
Disclosure: Nothing to disclose.

Vincenzo Orfeo, MD, Head, Operating Unit, Clinica Mediterranea, Naples, Italy
Vincenzo Orfeo, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Daniel S Durrie, MD, Director, Department of Ophthalmology, Division of Refractive Surgery, University of Kansas Medical Center
Daniel S Durrie, MD is a member of the following medical societies: American Academy of Ophthalmology and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Louis E Probst, MD, Medical Director of Refractive Surgery, Chicago, Madison, Milwaukee, and Windsor Centers, TLC the Laser Eye Centers
Louis E Probst, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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