Controlled reduction of postkeratoplasty astigmatism.

Corneal transplants were performed in 50 eyes using eight deeply placed interrupted 24 micron (10--0) monofilament nylon sutures followed by a more superficial continuous 16 micron (11--0) monofilament nylon suture placed around the wound in 16 equal bites. After surgery the 24 micron sutures in the steepest corneal meridian based on central and peripheral keratometry were cut. This suture technique permitted the donor cornea to assume its normal shape more rapidly while reducing the induced postkeratoplasty astigmatism. With this technique corneal astigmatism was reduced an average of 3.4 diopters (range 0--10 diopters), which allowed patient to achieve a mean visual acuity at three months of 20/50 and at 11 to 13 months of 20/35. Although this suture technique does not eliminate postkeratoplasty astigmatism, it permits the surgeon to reduce actively high degrees of astigmatism present after corneal transplantation.