Photorefractive keratectomy for severe postkeratoplasty astigmatism

We performed cylindric corneal ablations with the excimer laser on 12 patients to correct severe, disabling astigmatism after keratoplasty. In some patients, an additional ablation was performed to correct myopia. Patients were followed up for an average of eight months (range, six to 14 months). Uncorrected visual acuity improved in nine patients, and nine of the 12 patients had a decrease in refractive cylinder at last follow-up. The mean preoperative refractive cylinder was 7.0 ± 3.6 diopters, which decreased to a mean of 3.1 ± 2.6 diopters at one month (P = .0003) and 4.3 ± 2.9 diopters at last follow-up (P = .03). Keratometric astigmatism decreased from 7.5 ± 3.9 diopters preoperatively to 5.2 ± 3.9 diopters at the last follow- up (P = .001). Mean spherical equivalent was reduced from -7.4 ± 4.2 diopters preoperatively to -3.3 ± 4.4 diopters postoperatively (P = .003). Postoperative corneal haze, when present, did not reduce visual acuity. Excimer laser superficial keratectomy thus appears to be safe when used for postkeratoplasty ametropia, although substantial regression may limit its effectiveness in some patients.