Corneal lamellar flap retraction after LASIK following penetrating keratoplasty

Purpose: To describe a case of lamellar flap retraction after laser in situ keratomileusis (LASIK) to correct myopia and astigmatism after penetrating keratoplasty (PKP). Methods: Eleven months after PKP, a 34-year-old man underwent uneventful LASIK. Preoperative manifest refraction was -5.50 + 4.00 x 55, giving a best-corrected visual acuity (BCVA) of 20/20. Three days after LASIK, the central cornea was clear with a 1 - to 2-mm displacement and marked swelling of the inferior edge of the lamellar corneal flap, without central striae. The patient's uncorrected visual acuity (UCVA) was 20/60. The flap was repositioned, sutured with 6 10-0 nylon interrupted sutures, and covered with a bandage contact lens. Results: Five months after the repair, the cornea was clear, UCVA was 20/400, and manifest refraction was -9.50 + 6.00 x 75, giving a BCVA of 20/60. Three years later, manifest refraction was - 9.00 + 4.00 x 70, giving a BCVA of 20/40+2. Conclusion: In LASIK surgery after PKP, there is a risk of flap edema leading to retraction of the transplant wound. It may therefore be advisable to wait at least 1-2 years after PKP before performing LASIK. Patients who have corneal transplants should also be warned that they might have unique risks in LASIK treatment that may result in the loss of vision.