Post-keratoplasty Astigmatism

  • Kari KrootilaEmail author
  • Olli Wetterstrand
  • Juha Holopainen


Astigmatism is the leading factor to limit visual rehabilitation after otherwise successful keratoplasty. Reasons for post-keratoplasty astigmatism are multifactorial, and they can be divided into donor-related factors, recipient-related factors, intraoperative factors, and postoperative factors. In most reports the post-keratoplasty astigmatism is between two and four diopters after penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK). However, the amount of astigmatism varies and can be large enough to require surgical intervention to reach adequate optical correction. Endothelial transplantation does not usually induce astigmatism and surgical intervention is not necessary. The safest method to correct post-keratoplasty astigmatism is by use of spectacles followed by different types of contact lenses. Surgical correction of post-keratoplasty astigmatism includes astigmatic keratotomy, wedge resection, intracorneal ring segments, or excimer laser. Even higher amounts of regular corneal astigmatism can be corrected using toric intraocular lenses implanted both to phakic and pseudophakic eyes. Surgical treatment of post-keratoplasty astigmatism is always planned on individual basis and after careful examination. None of the single surgical methods fully correct the astigmatism, and often different surgical methods need to be combined. Here we have reviewed the reasons and different treatment modalities for post-keratoplasty astigmatism.


Post-keratoplasty astigmatism Toric IOL Femtosecond laser Astigmatic keratotomy Wedge resection Corneal transplantation 


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Kari Krootila
    • 1
    Email author
  • Olli Wetterstrand
    • 1
  • Juha Holopainen
    • 1
  1. 1.Department of OphthalmologyHelsinki University Eye Hospital and the University of HelsinkiHelsinkiFinland

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