Laser in situ keratomileusis to manage refractive errors after deep anterior lamellar keratoplasty

J Cataract Refract Surg. 2012 Jun;38(6):1020-7. doi: 10.1016/j.jcrs.2011.12.034.

Abstract

Purpose: To analyze the visual and refractive outcomes of laser in situ keratomileusis (LASIK) after deep anterior lamellar keratoplasty (DALK) for keratoconus.

Setting: Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey.

Design: Cohort study.

Methods: Patients with compound myopic astigmatism after DALK and a spherical equivalent (SE) between -2.50 diopters (D) and -8.00 D had LASIK as a single-step procedure, correcting the manifest refraction error. The visual and refractive results at 1 month, 3 months, and the last follow-up were compared with preoperative values.

Results: The mean follow-up was 11.17 months ± 3.61 (SD). The mean manifest refraction SE (MRSE) and autorefractometer measurements and the autokeratorefractometer and corneal topography keratometry readings decreased significantly from preoperatively to 1 month postoperatively (P<.01) but did not change significantly thereafter (P>.05). Preoperatively, the mean uncorrected (UDVA) and corrected (CDVA) distance visual acuities were 0.21 ± 0.08 and 0.73 ± 0.08, respectively; postoperatively, the means were 0.73 ± 0.10 and 0.98 ± 0.05, respectively. All eyes achieved a postoperative UDVA better than 0.5. No eye lost CDVA lines. The safety index was 1.34. The mean MRSE was -5.18 ± 1.74 D preoperatively and -1.05 ± 0.64 D postoperatively (P<.01). Postoperatively, 11 eyes (91.67%) were within ± 2.00 D of the SE, 8 (6.67%) were within ± 1.00 D, and 5 (41.67%) were within ± 0.50 D. No complications were encountered.

Conclusion: Treatment of post-DALK keratoconus patients with LASIK to correct manifest refraction error seems to be a viable option.

MeSH terms

  • Adult
  • Astigmatism / etiology
  • Astigmatism / physiopathology
  • Astigmatism / surgery*
  • Cohort Studies
  • Corneal Topography
  • Corneal Transplantation*
  • Female
  • Humans
  • Keratoconus / surgery*
  • Keratomileusis, Laser In Situ*
  • Lasers, Excimer / therapeutic use*
  • Male
  • Middle Aged
  • Myopia / etiology
  • Myopia / physiopathology
  • Myopia / surgery*
  • Postoperative Complications*
  • Refraction, Ocular / physiology
  • Retrospective Studies
  • Visual Acuity / physiology
  • Young Adult