The modern cataract surgeon is able to control the astigmatic result of cataract surgery whether a large, medium, or small incision technique is used. Placement of the surgical wound in front of, at, or behind the limbus, in combination with fine sutures, allows the surgeon to reduce astigmatism or, in some cases where there is pre-existing astigmatism, to induce a neutralizing astigmatic correction that will result in minimal postoperative astigmatism. For corneal transplantation, some surgeons feel that interrupted sutures assert more control over the ultimate astigmatic effect. The majority of cornea surgeons, however, still prefer the continuous 10-0 nylon suture with the possibility of postoperative adjustment. High degrees of astigmatism are still often seen with penetrating keratoplasty, despite the advent of the oversized donor button, and can be treated using various astigmatic procedures such as the Ruiz or modified Jensen. Surgery is undertaken to flatten the steep meridian by making transverse incisions. In those cases where the flattening effect is the dominant feature of the induced astigmatism, a wedge resection can be made to steepen the flat meridian. The predictability of wedge resections, however, is poor and the rehabilitation time long. However, the effects of transverse incisions made in the steep meridian are more predictable and recovery is more rapid. In those cases where myopia and astigmatism co-exist, radial incisions for the myopia, leaving an appropriate optical zone, are made. Moreover, an appropriate transverse incision or multiple transverse incisions on either side of an appropriate optical zone (in addition to that for the radial keratotomy) is required. Jensen's nomogram has proven to be realistic in mixed myopia with an astigmatism of up to 5 dioptres. Where a higher astigmatism exists, a modified Ruiz procedure may be more appropriate. Finally, where a 3.0-4.5 mm optical zone is effective with radial incisions in myopia, an optical zone size of 5.0-7.0 mm with transverse incisions is effective for co-existing idiopathic astigmatism.