[Severe astigmatism following transfixing keratoplasty: how to attempt to reduce it]. / Astigmatisme important après kératoplastie transfixiante: comment tenter de le réduire.

ABSTRACT

Surgical treatment of astigmatism has been practised since the nineteenth century. Ophthalmologists' attitude has to change with respect to the problem of astigmatism after penetrating keratoplasty. A high astigmatism must no longer be considered as a fatality, particularly in young patients, except in special circumstances to be considered case by case. Rather than waiting for corneal healing, and operating only some time after ablation of the edge-to-edge suture by practising for example a wedge resection, it appears logical to act sooner to benefit from the temporary flexibility of a recent scar. Initially, 5 or 6 very tight sutures should be inserted in the axis of the flatter meridian as a routine procedure. Overcorrection must be as high as the astigmatism to be corrected; the total correction achieved will be reduced by about 50% in the following weeks and will then become stable. The sutures have to be kept in position until the corneal scar is completely healed. Such a method has the drawback of remaining approximate, but this is also the case with other operations proposed at a later stage. It has the advantage of being simple and without risk of lasting overcorrection. This study was essentially a prospective and preliminary one, and analysis of results with more cases will determine whether this method is effective.