Two-stage LASIK for correction of refractive errors after penetrating keratoplasty

Purpose. To evaluate the efficiency of two-stage laser-assisted in situ keratomileusis (LASIK) for correction of spherical anisometropia and high astigmatism after penetrating keratoplasty (PKP). Patients and Methods. Retrospective analysis of 8 eyes from 8 patients who underwent two-stage LASIK after PKP for keratoconus. Results. After flap creation, there was a mean spherical shift of 2.32 diopters (D) (P < .01) and a mean astigmatic shift of 2.19 D (P < .01). After excimer laser treatment, there was a mean spherical shift of 2.41 D (P < .01) and a mean astigmatic shift of 3.97 D (P < .01). The spherical equivalent after the two-stage treatment was within 1 D of emmetropia in 7 eyes (87.5%). No patient experienced a reduction of best spectacle-corrected visual acuity (BSCVA) or uncorrected visual acuity (UCVA) after corneal flap creation or excimer laser treatment. The UCVA was 20/40 or better in 7 eyes (97.5%) and 20/30 or better in 5 eyes (62.5%), 6 months after completion of treatment. Conclusion. LASIK is effective in reducing spherical anisometropia and high astigmatism after PKP. Because of a statistically significant change in refractive error after creation of the LASIK flap, it is recommended that the procedure be performed in 2 stages.