Long-term analysis of LASIK for the correction of refractive errors after penetrating keratoplasty

Purpose: To determine the long-term safety and effectiveness of laser-assisted in situ keratomileusis (LASIK) in the treatment of refractive errors following penetrating keratoplasty. Methods: A retrospective review was done of 57 eyes of 48 patients with anisometropia or high astigmatism who were unable to wear glasses or a contact lens after penetrating keratoplasty and who underwent LASIK for visual rehabilitation. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), and corneal transplant integrity were recorded before surgery as well as up to 60 months after LASIK. Results: The mean follow-up after the LASIK was 21.4 ± 14.2 months (range, 3-60 months). Mean preoperative spherical equivalent (SE) was -4.19 ± 3.38 diopters (D). Mean preoperative astigmatism was 4.67 ± 2.18 D. Preoperative BCVA was 20/40 or better in 42 eyes (74%). At 2 years the mean SE was -0.61 ± 1.81 D and mean astigmatism was 1.94 ± 1.35 D for the 28 eyes with follow-up. UCVA was 20/40 or better in 12 eyes (43%), and BCVA was 20/40 or better in 24 eyes (86%) at 2 years. A gain in BCVA of one line or more was seen in eight eyes (29%). Two eyes (7%) had loss of two or more lines of BCVA at 2 years. Nine eyes (16%) developed epithelial ingrowth. Five eyes (9%) in this series had repeat corneal transplants. Conclusions: LASIK is effective for reducing ametropia after penetrating keratoplasty. Proper patient counseling is necessary because the results of LASIK after penetrating keratoplasty are not as good as, and complications are more frequent than, in eyes with naturally occurring myopia and astigmatism. Complications are especially common in patients with mismatch of the donor and host cornea and in those with poor endothelial cell function.