Two-step LASIK after penetrating keratoplasty

PURPOSE: The point of interest of this retrospective case review is to study refractive changes caused by the hinged lamellar keratotomy and the refractive outcome after laser ablation in a second step within the scope of laser in situ keratomileusis (LASIK) in patients with penetrating keratoplasty. METHODS: Data from eight patients obtained before lamellar keratotomy, before laser ablation, and three months later were evaluated. Keratotomies were performed with the Moria(®) LSK one and the Amadeus(®) 2 microkeratome, laser ablation was performed with the Schwind(®) Keratome I and the Wavelight(®) Allegretto WaveEyeQ. RESULTS: Uncorrected visual acuity (UCVA) improved significantly from 1 [logMar] to 0.4 [logMar] at the last visit. Median gain of UCVA was 7.38 ± 2.96 Snellen lines. Best spectacle-corrected visual acuity did not change significantly. Preoperative manifest refraction spherical equivalent decreased from −4.02 ± 4.77 diopters (D) to −1.11 ± 2.45 D after laser ablation. Mean preoperative manifest astigmatism was −7.27 ± 3.65 D, after lamellar keratotomy −6.72 ± 3.68 D, and after laser ablation −2.08 ± 1.80 D. Manifest astigmatism did not change significantly after the keratotomy. CONCLUSIONS: Lamellar keratotomy causes biomechanical changes to the cornea. We favor a two-step LASIK in penetrating keratoplasty patients in order to improve precision and predictability of the refractive outcome.