Post Keratoplasty Astigmatism Management by Relaxing Incision

Post-keratoplasty astigmatism is a common cause of suboptimal visual rehabilitation following corneal transplantation. Relaxing incisions may reduce corneal astigmatism by modifying the steepest corneal meridian. Objective: To determine the mean change in refractive astigmatism among post-keratoplasty patients undergoing topography-guided relaxing incisions. Methods: This quasi-experimental study was conducted at the Department of Ophthalmology, Layton Rehmatulla Benevolent Trust Eye Hospital, Township, Lahore, from 3 April to 3 July 2025. A total of 120 patients aged 20–70 years with post-keratoplasty astigmatism were enrolled through non-probability consecutive sampling. Topography-guided arcuate relaxing incisions were performed along the steepest corneal meridian. Refractive astigmatism was measured before the procedure and at three months postoperatively. Preoperative and postoperative values were compared using a paired-samples t-test, while stratified comparisons were performed using independent-samples t-tests. Results: The mean age of the patients was 45.56 ± 11.90 years, and 67 (55.8%) were male. Mean refractive astigmatism decreased significantly from 7.14 ± 1.33 D preoperatively to 5.18 ± 1.36 D at three months. The mean reduction was 1.96 ± 0.93 D, representing a 27.4% decrease from baseline (95% CI: 1.79–2.13; p < 0.001). The reduction did not differ significantly according to gender, age or duration since keratoplasty. However, patients with baseline astigmatism greater than 7.0 D experienced a significantly greater reduction than those with astigmatism of 7.0 D or less (2.18 ± 0.87 D versus 1.66 ± 0.93 D; p = 0.002). Conclusion: Topography-guided relaxing incisions significantly reduced refractive astigmatism at three months after treatment and produced consistent improvement across major demographic and clinical subgroups.