Femtosecond LASIK combined with astigmatic keratotomy for the correction of refractive errors after penetrating keratoplasty.

BACKGROUND AND OBJECTIVE: To evaluate the outcomes of femtosecond laser in situ keratomileusis (LASIK) compared to combined LASIK and astigmatic keratotomy in the treatment of refractive errors following penetrating keratoplasty.

PATIENTS AND METHODS: A retrospective review was performed on 18 eyes of 16 patients who underwent LASIK for visual rehabilitation after penetrating keratoplasty. Seven eyes (38.8%) had undergone paired relaxing incisions with topographic guidance prior to LASIK performance.

RESULTS: Preoperative uncorrected visual acuity was 20/100 or worse in 13 eyes (72.2%) and best-corrected visual acuity (BCVA) was 20/40 or better in 15 eyes (83.3%). After LASIK, uncorrected visual acuity was 20/40 or better in 10 eyes (55.5%) and BCVA was 20/40 or better in 17 eyes (94.4%). Three eyes (16.6%) had a loss of 1 to 2 lines of BCVA. No difference in visual outcomes was noted in eyes undergoing LASIK and astigmatic keratotomy versus LASIK alone. An increased complication rate was noted in patients who also underwent astigmatic keratotomy and was associated with flap creation.

CONCLUSION: Femtosecond LASIK is effective in reducing ametropia after penetrating keratoplasty. Astigmatic keratotomy might complicate flap creation in LASIK; therefore, photorefractive keratectomy should be considered for patients who had previous astigmatic keratotomy to reduce astigmatism.