To present the results of corneal wedge resection in postkeratoplasty astigmatism, performed by the same surgeon using the same nomogram over a 25-year period.This is a retrospective observational study. The sample was obtained from the medical records of all patients who underwent penetrating or deep lamellar keratoplasty, performed by a single surgeon from 1993 to 2018. All surgeries were performed using a diamond knife, on the flat meridian, involving the keratoplasty scar and closed with five 10-0 nylon sutures.A total of 39 eyes were included. The keratometry measured cylinder improved from 7.99 ± 0.25 to 2.5 ± 0.3 D at 12 months and remained stable thereafter (a mean follow-up of 76.3 months). Best spectacle corrected visual acuity increased from 0.35 ± 0.01 to 0.57 ± 0.02 at 12 months and remained stable thereafter. There was a coupling ratio of 0.08 ± 0.03 D at 12 months. There were no corneal graft rejections or loss of best spectacle corrected visual acuity on this series.Corneal wedge resection is a valuable resource for the management of high postkeratoplasty astigmatism. It is a safe and reproducible procedure, with stable results at 12 months and thereafter.