Effect of hinged lamellar keratotomy on postkeratoplasty eyes

Ophthalmology. 2001 Oct;108(10):1845-51; discussion 1851-2. doi: 10.1016/s0161-6420(01)00702-3.


Purpose: To evaluate the effect of a hinged lamellar keratotomy on refraction, vision, and corneal topography of postkeratoplasty eyes with high-degree astigmatism.

Design: Noncomparative, interventional case series.

Participants: A hinged lamellar keratotomy was performed on nine eyes of nine patients at least 9 months after penetrating keratoplasty and with high-degree astigmatism. All patients were spectacle and contact lens intolerant.

Intervention: A superiorly hinged lamellar keratotomy (corneal flap), 160 microm in thickness and 9 mm in diameter, was created on all eyes included in this study. Each patient was examined 1 day, 1 month, and 3 months after surgery.

Main outcome measures: Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, computerized analysis of corneal topography.

Results: At each postoperative examination time, there was a significant reduction in both average spherical equivalent (P < 0.05) and average absolute value of astigmatism (P < 0.01) over mean preoperative values. The major changes were seen as early as 1 day after surgery, but both progression and regression of the effect were documented at later postoperative examinations. In all patients best spectacle-corrected acuity was maintained or improved after the procedure. Postoperatively, four patients could be successfully corrected either with spectacles (n = 2) or with gas-permeable contact lenses (n = 2). There were no surgical flap or corneal graft complications.

Conclusions: Hinged lamellar keratotomy improves vision and refraction of postkeratoplasty eyes with high-degree astigmatism. In some cases it may be so effective as to make planned excimer laser treatment unnecessary.

MeSH terms

  • Adult
  • Aged
  • Anisometropia / surgery*
  • Astigmatism / physiopathology
  • Corneal Stroma / surgery*
  • Corneal Topography
  • Female
  • Humans
  • Keratomileusis, Laser In Situ*
  • Keratoplasty, Penetrating*
  • Male
  • Middle Aged
  • Postoperative Complications / surgery*
  • Refraction, Ocular
  • Surgical Flaps
  • Treatment Outcome
  • Visual Acuity