Laser in situ keratomileusis for the correction of residual ametropia after penetrating keratoplasty

PURPOSE: To evaluate the safety, efficacy, and predictability of excimer laser in situ keratomileusis (LASIK) to correct residual myopia and astigmatism after penetrating keratoplasty (PKP). SETTING: Buzard Eye Institute, Las Vegas, Nevada, USA. METHODS: Twenty-six eyes had LASIK at least 1 year after PKP. All eyes were followed for at least 6 months after LASIK; 22 eyes were followed for 12 months. Sutures were removed at a mean of 13 months post PKP. Laser in situ keratomileusis was performed with the Chiron Automated Corneal Shaper microkeratome (Bausch & Lomb) and the Visx Star excimer laser. Before LASIK, the mean spherical equivalent (SE) was -4.94 diopters (D) +/- 2.79 (SD) and the mean astigmatism was 2.71 +/- 2.33 D; all eyes had regular astigmatism or slightly decentered, irregular astigmatism. RESULTS: At the last follow-up, the mean postoperative uncorrected visual acuity (UCVA) was 20/30, the mean SE was -0.35 +/- 0.65 D, and the mean residual astigmatism was 1.06 +/- 0.67 D. Eighty-six percent of patients had an SE within +/-1.00 D of emmetropia and a UCVA of 20/40 or better. Ten eyes (39%) had 1 or more enhancements, which were performed a mean of 6 months after the primary LASIK. Significant complications such as wound dehiscence, epithelial ingrowth, and corneal decompensation did not occur. At the last follow-up, 18% of patients lost 1 line of best corrected visual acuity and 27% gained 1 line. CONCLUSION: Laser in situ keratomileusis appeared to be a reliable and safe procedure to correct residual myopia and astigmatism after PKP.