Refractive keratoplasty using modified relaxing incisions with compression sutures was performed on 33 patients with high post-keratoplasty astigmatism. The mean reduction in keratometric astigmatism was 8.38 dioptres from a preoperative mean of 12.21 dioptres (SD, 3.59) to 3.93 dioptres (SD, 2.13). All patients noted a marked functional improvement. Two patients required reoperation. One patient required resuturing. Our modification of undercutting the relaxing incisions greatly increases the range of astigmatism that can be treated with this technique.