Introduction: Our purpose was to report our management strategies and their results performed for visual rehabilitation after penetrating keratoplasty (PK).
Patients and Methods: The records of 104 eyes of 98 patients (54male/44 female) who underwent PK between January 2013 and January 2015 in Baskent University Faculty of Medicine, Department of Ophthalmology were reviewed. The age, the indication for PK, interventions performed for visual rehabilitation, the duration of follow-up, the topographic and refractive astigmatism at the end of follow-up and the final BCVA were recorded. 
Results: The mean age of the patients was 54±23 years. The indications for PK included keratoconus, Fuch's endothelial dystrophy, pseudophakic bullous keratopathy and corneal scarring. All surgeries were performed by a single experienced surgeon (DDA). The mean duration of follow up was 23±11.5 months. Suture adjustment and selective suture removal were performed 2 to 6 weeks and after 3 months in eyes with more than 3 D of corneal astigmatism in patients who had continuous and interrupted sutures, respectively. Spectacle correction was performed in 86 eyes (83%) and contact lenses including rigid gas permeable and scleral lenses were fitted in 18 eyes (17%) who were unsatisfied with spectacle correction mostly due to higher order aberrations or high anisometropia. Relaxing corneal incisions were performed in 23 eyes (22%) and toric intraocular lens implantation was performed in 34 eyes (33%) with cataracts. The mean topographic and absolute refractive astigmatism at the end of follow up was 3.4±2.6 D and 3.6± 1.9 D, respectively. Fifty percent of the patients had a final BCVA higher than 6/10. 
Conclusions: Suture manipulation has been described for minimising early postoperative astigmatism. If significant astigmatism remains after suture removal, which cannot be corrected by optical means such as spectacle correction or contact lenses, 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. Although general guidelines are useful, it is important to individualize and modify the management based on corneal topography and patient expectations for the initial and subsequent visual rehabilitation.