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Article
July 1993

Keratotomy for Astigmatism Using an Arcuate Keratome

Author Affiliations

From the Ophthalmology Department, Hôpital Hotel-Dieu, Paris, France (Dr Hanna); the Department of Ophthalmology, Emory University Medical School, Atlanta, Ga (Drs Hanna, Hayward, Hagen, and Waring); and the Bascom Palmer Eye Institute, Miami, Fla (Drs Simon and Parel). Dr Hanna has a proprietary interest in the instrument described in this article. The other authors have no proprietary, interest in the instrument.

Arch Ophthalmol. 1993;111(7):998-1004. doi:10.1001/archopht.1993.01090070118030
Abstract

We describe a new system for performing transverse arcuate corneal incisions for the correction of astigmatism. The instrument consists of a conical housing with suction and/or friction fixation to the limbus and two micrometric diamond knives mounted on a carrier that can be rotated by a gear mechanism. The depth, length, and location of the incisions can be predetermined. Light microscopy of donor eye corneas documented the achieved incision depth. One sweep at normal speed produced an incision depth 28% less deep than the preset depth. One sweep at low speed achieved depths of approximately 100% of the knife setting. Variability from one incision to another in the same cornea was related to blade sharpness. We report successful use of the instrument in five consecutive eyes with naturally occurring astigmatism.

References
1.
Snellen H.  Die Richtung der Hauptmeridiäne des astigmatischen Auges . Arch Ophthalmol . 1869;15:199-207.
2.
Lans U.  Experimentelle Untersuchungen uber Entstehung von Astigmatismus durch nicht-perforirende Corneawunden . Arch Ophthalmol . 1898;45:117-152.
3.
Bates WH.  A suggestion of an operation to correct astigmatism . Arch Ophthalmol . 1894;23:9-13.
4.
Schimmelpfennig BH, Waring GO.  Development of refractive keratotomy in the nineteenth century . In: Waring GO. Refractive Keratotomy for Myopia and Astigmatism . St Louis, Mo: Mosby—Year Book; 1991:171-177.
5.
Sato T.  Posterior incision of the cornea: surgical treatment for conical cornea and astigmatism . Am J Ophthalmol . 1950;33:943-948.
6.
Troutman RC.  Microsurgical control of corneal astigmatism in cataract and keratoplasty . Trans Am Acad Ophthalmol Otolaryngol . 1973;77:OP563-OP572.
7.
Troutman RC, Swinger CA.  Relaxing incisions for control of postoperative astigmatism following keratoplasty . Ophthalmic Surg . 1980;11:117-120.
8.
Krachmer JH, Fenzl RL.  Surgical correction of high postkeratoplasty astigmatism: relaxing incisions versus wedge resection . Arch Ophthalmol . 1980;98:1400-1402.Article
9.
Swinger CA.  Postoperative astigmatism . Surv Ophthalmol . 1987;31:219-248.Article
10.
Lindstrom RL, Lindquist TD.  Surgical correction of postoperative astigmatism . Cornea . 1988;7:138-148.Article
11.
Rowsey JJ.  Review: current concepts in astigmatism surgery . J Refract Surg . 1986;2:85-94.
12.
Binder PS, Waring GO.  Keratotomy for astigmatism . In: Waring GO. Refractive Keratotomy for Myopia and Astigmatism . St Louis, Mo: Mosby—Year Book; 1991:1085-1198.
13.
Thornton SP, Sanders DR.  Graded nonintersecting transverse incisions for correction of idiopathic astigmatism . J Cataract Refract Surg . 1987;13:27-31.Article
14.
Merlin U.  Curved keratotomy procedure for congenital astigmatism . J Refract Surg . 1987;3:92-97.
15.
Duffey RJ, Jain VN, Tchah H, Hofmann RF, Lindstrom RL.  Paired arcuate keratotomy: a surgical approach to mixed and myopic astigmatism . Arch Ophthalmol . 1988;106:1130-1135.Article
16.
Waring GO, Hanna KD.  The Hanna suction punch block and trephine system for penetrating keratoplasty . Arch Ophthalmol . 1989;107:1536-1539.Article
17.
Lowery JA, Parel J-M, Roussel TJ, Simon G, Lee W, Nose I.  Artificial orbit system for experimental surgery with enucleated globes . Ophthalmic Surg . 1990;21:522-528.
18.
Thornton SP, Gardner SK, Waring GO.  Surgical instruments used in refractive keratotomy . In: Waring GO. Refractive Keratotomy for Myopia and Astigmatism . St Louis, Mo: Mosby—Year Book; 1991:407-489.
19.
Seiler T, Bende T, Wollensak J, Trokel S.  Excimer laser keratectomy for correction of astigmatism . Am J Ophthalmol . 1988;105:117-124.
20.
McDonnell PJ, Moreira H, Clapham TN, D'Arcy J, Munnerlyn CR.  Photorefractive keratectomy for astigmatism: initial clinical results . Arch Ophthalmol . 1991;109:1370-1373.Article
21.
Dehm EF, Puliafito CA, Adler CM, Steinert RF.  Corneal endothelial injury in rabbits following excimer laser ablation at 193 nm and 248 nm . Arch Ophthalmol . 1986;104:1364-1368.Article
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