ABSTRACT
Despite improvements in outcomes of penetrating keratoplasty, postoperative astigmatism remains a challenge. This review describes the various techniques used to minimize postoperative penetrating keratoplasty astigmatism. The advent of descemet stripping endothelial keratoplasty for corneal disorders involving the endothelium has decreased the incidence of postoperative astigmatism. Spectacles, contact lenses, and refractive surgical techniques are used in various situations to manage high postoperative astigmatism and improve functional vision. Refractive surgical procedures discussed in this review include excimer laser photorefractive keratectomy and laser in situ keratomileusis, mechanical and femtosecond laser incisional keratotomy, wedge resection, and intraocular lens implantation