Limbal wedge resection at the time of intraocular lens surgery for reducing postkeratoplasty astigmatism.

Thirteen limbal wedge resections performed to reduce postkeratoplasty astigmatism in patients undergoing secondary intraocular lens placement were reviewed. Eleven of the 13 procedures reduced preoperative astigmatism 3.12 diopters (+/- 1.77 D; range, 0.50 D to 6.25 D). The average follow-up time was 17 months (range, 4 to 36 months). The average flat/steep ratio was 1.19 (+/- 0.96), indicating approximately equal degrees of corneal flattening and steepening. Average central corneal keratometric values steepened 0.47 D, with a range of 0.56 D of flattening to 2.41 D of steepening. Keratometric values were stable by 4 months in most patients. All patients except one with amblyopia had a corrected visual acuity of 20/60 or better. A dellen formation developed in one case, but it caused no permanent negative visual complications. As generally found in previous studies, each 0.1-mm wedge-width resected induced 1 D of astigmatic correction. Limbal wedge resection in conjunction with intraocular lens implantation can safely and effectively reduce astigmatism following penetrating keratoplasty.