Photorefractive keratectomy with mitomycin-C after corneal transplantation for keratoconus.

PURPOSE: To evaluate the efficacy of photorefractive keratectomy (PRK) for residual refractive error after penetrating keratoplasty (PKP) for keratoconus.

SETTING

Private ophthalmic clinic.

DESIGN

Case series.

METHOD: Consecutive patients who had PRK augmented with topical mitomycin-C (MMC) after PKP for keratoconus were retrospectively reviewed. Patients were divided into a a low cylinder group (refractive cylinder ≤ 6.00 D) and a high cylinder group (refractive cylinder >6.00 D). Visual acuity, refraction, and keratometry were analyzed preoperatively and 1, 3, 6, and 12 months postoperatively.

RESULTS

The study comprised 47 eyes (41 patients). The spherical equivalent (SE) decreased from -4.24 D ± 3.23 (SD) preoperatively to -0.71 ± 1.03 D 12 months postoperatively in the low cylinder group and from -4.19 ± 3.54 D to -2.45 ± 3.42 D, respectively, in the high cylinder group. The refractive cylinder decreased from -4.27 ± 1.4 D to -1.71 ± 1.55 D, respectively, in the low cylinder group and from -7.78 ± 1.21 D to -4.6 ± 2.54 D, respectively, in the high cylinder group. By the last follow-up, 8.3% of patients had lost 2 lines of corrected distance visual acuity. There were no cases of corneal haze greater than 2+ or of graft rejection.

CONCLUSIONS

Penetrating keratoplasty with adjunctive MMC decreased several refractive variables in patients with previous PKP. These results compare well with those in the published literature and suggest PRK is as effective as, and probably safer than, laser in situ keratomileusis in treating refractive error in these cases.

FINANCIAL DISCLOSURE: No author has financial or proprietary interests in any material or method mentioned.