Seventy eight patients (156 eyes) were treated by radial keratotomy. Patients with spherical axial myopia were selected (including 39% of physiological astigmatism cases). After radial conventional technique the against-the-rule astigmatism > 1.0 D is 31.6% and between 1.0 and 2.0 D is 3.4% versus 0.6% (< 1.0 D) and 0.1% (1.0-2.0 D) with the modified technique. To decrease the frequency of the against-the-rule postoperative astigmatism after RK procedure we performed 1 or 2 vertical additional flag-incisions on the horizontal meridian to counteract the effect of the corneal oedema on the superior incisions.

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