Post-keratoplasty astigmatism management by relaxing incisions: a systematic review

Ho Wang Yin, Gaëlle; Hoffart, Louis

doi:10.1186/s40662-017-0093-7

Eye and Vision

Table 1 Main results studies

From: Post-keratoplasty astigmatism management by relaxing incisions: a systematic review

Authors	N	Study type	Treatment		Location	Refractive (R) or keratometric (K) cylinder			Complications
Authors	N	Study type	Treatment		Location	Pre-op (D)	Post-op (D)	Reduction (%)	Complications
Krachmer & Fenzl, 1980 [52]	16	Retrospective, comparative case series	Manual paired relaxing incision Depth = 50% to 66% CCT Length = 60° Graft-host interface		Graft-host interface	10.11 (K)	5.79 (K)	43 (K)	2 perforations
Price & Whitson, 1991 [55]	111	Retrospective case series	Manual paired relaxing incision Depth and length variable		Graft or graft-host interface	6.18 ± 1.56 (R)	3.34 ± 1.96 (R)	46 (R)	12 wound dehiscences
Hjortdal & Ehlers, 1998 [56]	21	Nonrandomized retrospective study	Manual relaxing incision Depth = central corneal thickness Length = 45°; 5 or 6 mm from optical zone		Graft	7 (R)	3.25 (R)	54 (R)	None
Hannush et al., 1998 [57]	29	Retrospective case series	Manual paired relaxing incision Depth = 75% CCT Length = not available 0.5 mm inside the graft-host interface		Graft	8.8 ± 3.1 (K)	3.2 ± 3.0 (K)	64 (K)	None
Borderie et al., 1999 [58]	22	Retrospective case series	Manual paired relaxing incision with Hanna arcitome Depth = 75% thinnest pachymetry Length = 60° to 80° 6 to 6.75 mm zone diameter (Hanna nomogram [38])		Graft	6.94 ± 2.11 (R)	3.85 ± 1.95 (R)	44 (R)	1 perforation, 1 overcorrection (same patient)
Borderie et al., 1999 [58]	22	Retrospective case series			Graft	9.02 ± 2.67 (K)	3.94 ± 2.19 (K)	56 (K)	1 perforation, 1 overcorrection (same patient)
Koay et al., 2000 [59]	34	Nonrandomized retrospective study	Manual relaxing incision and compression sutures Depth = 480 μm Length = 45°		Graft-host interface	9.69 ± 3.51 (R)	3.92 ± 2.16 (R)	59.5 (R)	1 graft rejection
Koay et al., 2000 [59]	34	Nonrandomized retrospective study			Graft-host interface	9.14 ± 4.38 (K)	3.59 ± 1.92 (K)	60.7 (K)	1 graft rejection
Wilkins et al., 2005 [35]	20	Nonrandomized retrospective study	Manual relaxing incision Depth = 600 μm Length = 60°; 6 mm from optical zone		Host	10.99 ± 4.26 (R)	3.33 ± 2.18 (R)	72 (R)	None
Bochmann & Schipper, 2006 [12]	11	Nonrandomized retrospective study	Manual relaxing incision Depth = 80% of peripheral corneal thickness Length = 30° to 90° 9 to 10 mm zone diameter		Host	6.1 ± 2.5 (R)	3.3 ± 0.7 (R)	45.9 (R)	None
Bochmann & Schipper, 2006 [12]	11	Nonrandomized retrospective study			Host	9.02 ± 3.54 (K)	3.41 ± 1.21 (K)	62.2 (K)	None
Geggel 2006, [50]	26	Nonrandomized retrospective observational case series	Manual relaxing incision Depth = 80% of the thinnest pachymetry on the meridian Length = 35° to 90° 0.5 mm or 1 mm inside the graft-host junction if >10 D		Graft	8.7 ± 2.4 (K)	3.25 ± 1.74 (K)	63 (K)	None
Poole & Ficker, 2006 [60]	39	Nonrandomized retrospective study	Manual relaxing incision Depth = 90% CCT Length = 45° to 90°, 0.5 mm inside the graft-host interface		Graft	9.13 (R)	4.85 (R)	47 (R)	1 perforation
Hoffart et al., 2007 [61]	40	Nonrandomized retrospective study	Manual relaxing incision Depth = 75% CCT, length = 60° to 80° 6 to 6.75 mm zone diameter (Hanna nomogram [38])		Graft	8.84 ± 3 (R)	4.88 ± 2.5 (R)	45 (R)	1 perforation, 2 rejections
Bahar et al., 2008 [62]	40	Retrospective, comparative case series	FS: Depth = 90% CCT Length = 60° to 90° 0.5 mm inside the graft-host junction	Manual: Depth = 500 μm Length = 45° to 90° 0.5 mm inside the graft-host junction	Graft	FS: 7.84 ± 2.35 (K)	FS: 3.58 ± 2.21 (K)	FS: 54 (K)	FS: 5 overcorrections, 1 rejection
Bahar et al., 2008 [62]	40	Retrospective, comparative case series			Graft	Manual: 7.80 ± 3.14 (K)	Manual: 4.58 ± 2.95 (K)	Manual: 41 (K)	3 perforations,6 overcorrections, 1 infection
Buzzonetti et al., 2009 [63]	9	Prospective non- comparative study	FS, paired symmetric incisions 90° angled Depth = 80% thinnest pachymetry Length = 70° Optical zone = 4.8 to 6.8 mm		Graft	9.10 ± 3.90 (R)	3.10 ± 1.50 (R)	66 (R)	None
Buzzonetti et al., 2009 [63]	9	Prospective non- comparative study			Graft	9.80 ± 1.90 (K)	5.20 ± 1.50 (K)	47 (K)	None
Nubile et al., 2009 [64]	12	Prospective noncomparative interventional case series.	FS, paired symmetric incisions 90° angled Depth = 90% pachymetry on incision location Length = 40° to 80 ° 1 mm inside the graft-host junction		Graft	7.16 ± 3.07 (R)	2.39 ± 1.62 (R)	66 (R)	2 perforations
Hoffart et al., 2009 [39]	20	Prospective comparative randomized study	FS or Hanna arcitome Depth = 75% thinnest pachymetry Length = 60° to 80° 6 to 6.75 mm zone diameter (Hanna nomogram [38])		Graft	FS: 8.6 ± 3 (R)	FS: 3.9 ± 2.4 (R)	FS: 55 (R)	1 perforation
Hoffart et al., 2009 [39]	20	Prospective comparative randomized study			Graft	Hanna: 6.7 ± 2.1 (R)	Hanna: 4.7 ± 2.4 (R)	Hanna: 30 (R)	1 perforation
Kumar et al. 2010 [65]	34	Retrospective case series	FS, paired symmetric incisions Depth = 90% pachymetry on incision location Length = 40° to 60 ° (<6 D), 65° to 75° (6 to 10 D), 90° (> 10 D) 0.5 mm inside the graft-host junction		Graft	7.46 ± 2.7 (K)	4.77 ± 3.29 (K)	36 (K)	3 rejections, 9 overcorrections (24%)
Fares et al., 2013 [66]	26	Nonrandomized prospective study	Manual relaxing incision with compression suture Depth = 80% CCT Length = 45° (6 D to 9 D) to 60° (>9 D) 7 mm zone diameter		Interface	9.66 ± 2.9 (R)	4.37 ± 2.53 (R)	58.4 (R)	1 perforation
Cleary et al., 2013 [42]	6	Prospective noncomparative interventional case series	FS beveled Bevel angle of 135° Depth = 65% to 75% CCT Length = 60° to 90° 0.4 mm inside the graft margin		Graft	9.8 ± 2.9 (K)	4.5 ± 3.2 (K)	57 (K)	None
Loriaut et al., 2015 [67]	20	Retrospective case series	FS Depth = 75% thinnest pachymetry Length = 60° to 80° 6 to 6.8 mm zone diameter (Hanna nomogram [38])		Graft	9.45 ± 2.97 (K)	4.64 ± 2.79 (K)	50.9 (K)	10 overcorrections
Al Sabaani et al., 2016 [41]	52	Retrospective non-comparative interventional study	FS Depth = 75% - 85% thinnest pachymetry Length = 50° to 70° (Nordan nomogram [41]) 0.5-0.7 mm within the graft-host junction		Graft	7.15 ± 1.32 (R)	5.19 ± 2.25 (R)	27.4 (R)	3 perforations, 12 overcorrections
Hashemian et al., 2017 [68]	23	Prospective interventional case series	FS Depth = 85% thinnest pachymetry Length = 40° to 90° (Wu [69] and Kumar [65] nomogram) 1 mm within the graft-host junction		Graft	7.79 ± 2.64 (R)	3.69 ± 2.25 (R)	52.6 (R)	2 perforations

CCT = central corneal thickness; FS = femtosecond laser assisted

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