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Hindawi Publishing Corporation Journal of Ophthalmology Volume 2011, Article ID 708736, 8 pages doi:10.1155/2011/708736 Review Article Current Approaches for Management of Postpenetrating Keratoplasty Astigmatism Sepehr Feizi and Mohammad Zare Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran 16666, Iran Correspondence should be addressed to Mohammad Zare, drzarea@ Received 29 March 2011; Accepted 6 June 2011 Academic Editor: Edward Manche Copyright © 2011 S. Feizi and M. Zare. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. A successful corneal graft requires both clarity and an acceptable refraction. A clear corneal graft may be an optical failure if high astigmatism limits visual acuity. Intraoperative measures to reduce postkeratoplasty astigmatism include round and central trephination of cornea with an adequate size, appropriate sutures with evenly distributed tension, and perfect graft-host apposition. Suture manipulation has been described for minimising early postoperative astigmatism. If significant astigmatism remains after suture removal, which cannot be corrected by optical means, then further surgical procedures containing relaxing incisions, compression sutures, laser refractive surgery, insertion of intrastromal corneal ring segments, wedge resection, and toric intraocular lens implantation can be performed. When astigmatism cannot be reduced using one or more abovementioned approaches, repeat penetrating keratoplasty should inevitably be considered. However, none of th