Advancements in the management of astigmatism following keratoplasty

Keratoplasty is currently an effective method for treating corneal blindness. Although the overall success rate of keratoplasty has significantly improved with the advancement of surgical techniques and the development and application of anti-rejection drugs, various complications may still occur after the operation, such as poor corneal healing, interlamellar fluid or blood accumulation, graft dislocation, infection and secondary glaucoma. In addition, secondary refractive changes often accompany keratoplasty, among which astigmatism is the most prominent and has always been an important factor affecting the recovery of postoperative visual function. It is reported that as many as one-fifth of patients will eventually develop astigmatism greater than 5 diopters. This article reviews the progress in the treatment of post-keratoplasty astigmatism, including three stages: the first stage involving adjusting continuous sutures and selectively removing interrupted sutures, the second stage including eyeglasses and contact lenses and the third stage covering photorefractive keratectomy laser in situ keratomileusis, femtosecond laser small incision lenticule extraction, femtosecond-assisted arcuate keratotomy, corneal wedge resection, intrastromal corneal ring segment implantation, toric intraocular lens implantation, toric intraocular collamer lens implantation, repeat keratoplasty, and surgical precautions, with the aim of providing references for clinical practice and research.