To evaluate the effectiveness and predictability of multiple arcuate keratotomy (AK) for post-keratoplasty astigmatism.

Eight eyes from six patients were included. Paired 60° arc length AKs centred on the steep axis were carried out 0.5 mm within the graft-host junction. If there was residual astigmatism more than 5 diopters after the first pair of AK another pair of AK was done. The depth of the AKs was set at approximately 80-90% of the depth of the cornea, based on a topographic pachymeter at the incision location. The outcome measures included preoperative and postoperative topographic astigmatism, uncorrected and corrected visual acuity, surgical complications and repeat procedures.

Only in 2 eyes out of 8 residual astigmatism was less than 5 with the first pair of incisions. Six eyes needed second pair of incisions to obtain the desired result. There were no need for suturing for overcorrection or wound gape.. The mean preoperative astigmatism was 8.5±4.3 dioptres (D); the postoperative astigmatism at the last visit was 3.2±2.2 D.

In treatment of post-keratoplasty astigmatism, multiple concentric Arcuate keratotomy can be used efficently.