Laser in situ keratomileusis to correctrefractive errors after keratoplasty

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Abstract
To assess the safety and effectiveness of excimer laser in situ keratomileusis (LASIK) to correct refractive myopia, astigmatism, or both after keratoplasty. Eye Clinic Day Hospital, São Paulo, Brazil. Twenty-two eyes that had previously had corneal transplantation were studied. Laser in situ keratomileusis was performed using the Chiron automated microkeratome and the VISX Twenty-Twenty B excimer laser. Mean follow-up after LASIK was 10.09 months +/- 3.87 (SD). The spherical equivalent refraction dropped from -4.55 +/- 3.66 D before LASIK to -0.67 +/- 1.24 D after surgery. At the last examination, 72.7% of patients had a refractive error within +/- 1.00 D of emmetropia and 54.5% had uncorrected visual acuity of 20/40 or better. Vector analysis of astigmatic correction showed an index of success of 54.0%. Best spectacle-corrected visual acuity was unchanged in 8 cases, improved in 9, and decreased in 5. Significant endothelial cell loss, keratoplasty wound dehiscence, and other serious complications did not develop in any eye. The correction of refractive error with LASIK in postkeratoplasty patients proved to be safe, effective, and predictable. Further studies with longer follow-up are needed to determine the method's clinical value.