title: Effect of hinged lamellar keratotomy on postkeratoplasty eyes.
abstract: OBJECTIVE
  To evaluate the effect of a hinged lamellar keratotomy on refraction, vision, and corneal topography of postkeratoplasty eyes with high-degree astigmatism.
  
  
  METHODS
  Noncomparative, interventional case series.
  
  
  METHODS
  A hinged lamellar keratotomy was performed on nine eyes of nine patients at least 9 months after penetrating keratoplasty and with high-degree astigmatism. All patients were spectacle and contact lens intolerant.
  
  
  METHODS
  A superiorly hinged lamellar keratotomy (corneal flap), 160 microm in thickness and 9 mm in diameter, was created on all eyes included in this study. Each patient was examined 1 day, 1 month, and 3 months after surgery.
  
  
  METHODS
  Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, computerized analysis of corneal topography.
  
  
  RESULTS
  At each postoperative examination time, there was a significant reduction in both average spherical equivalent (P < 0.05) and average absolute value of astigmatism (P < 0.01) over mean preoperative values. The major changes were seen as early as 1 day after surgery, but both progression and regression of the effect were documented at later postoperative examinations. In all patients best spectacle-corrected acuity was maintained or improved after the procedure. Postoperatively, four patients could be successfully corrected either with spectacles (n = 2) or with gas-permeable contact lenses (n = 2). There were no surgical flap or corneal graft complications.
  
  
  CONCLUSIONS
  Hinged lamellar keratotomy improves vision and refraction of postkeratoplasty eyes with high-degree astigmatism. In some cases it may be so effective as to make planned excimer laser treatment unnecessary.
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: M
authors.initials: M
authors.lastname: Busin
authors.forename: R C
authors.initials: RC
authors.lastname: Arffa
authors.forename: L
authors.initials: L
authors.lastname: Zambianchi
authors.forename: G
authors.initials: G
authors.lastname: Lamberti
authors.forename: A
authors.initials: A
authors.lastname: Sebastiani
mesh_terms: D000328:Adult; D000368:Aged; D015858:Anisometropia / Q000601:surgery*; D001251:Astigmatism / Q000503:physiopathology; D003319:Corneal Stroma / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012029:Refraction, Ocular; D013524:Surgical Flaps; D016896:Treatment Outcome; D014792:Visual Acuity