title: Corneal perforation during laser in situ keratomileusis after hyperopic electrothermal keratoplasty.
abstract: OBJECTIVE
  To report a corneal perforation during laser in situ keratomileusis (LASIK) after previous electrothermokeratoplasty.
  
  
  METHODS
  Interventional case report.
  
  
  METHODS
  A 49-year-old man presented with primary hyperopia in the right eye and residual hyperopia after electrothermokeratoplasty in the left eye. His refraction was +4.00 in the right eye and +7.00 -3.00 x 135 degrees in the left eye, with a central pachymetry of 535 microm and 549 microm, respectively. Phacoemulsification with intraocular lens (IOL) insertion in the right eye and a two-step keratophacorefractive procedure with a piggyback IOL insertion and LASIK in the left eye were proposed.
  
  
  RESULTS
  Postoperative refraction was -0.50 -0.50 x 150 degrees 20/20 in the right eye. Postphacoemulsification refraction was -4.75 -4.25 x 135 degrees in the left eye. Laser in situ keratomileusis was performed in the left eye, 4 months later, with uneventful astigmatic laser ablation. During the myopic ablation, a sudden outcome of aqueous humor in one of the temporal corneal scars was observed.
  
  
  CONCLUSIONS
  Unpredictably thin areas after electrothermokeratoplasty may lead to unexpected corneal perforation during LASIK. The available pachymetry systems may be unreliable after electrothermal keratoplasty.
authors.affiliation: Department of Ophthalmology, Cornea, External Diseases and Refractive Surgery Service, Centro Médico Docente La Trinidad, Caracas, Venezuela.
authors.forename: María M
authors.initials: MM
authors.lastname: Silva-Díaz
authors.forename: Ashley
authors.initials: A
authors.lastname: Behrens
authors.forename: Francia Y
authors.initials: FY
authors.lastname: Torres
authors.forename: Gustavo
authors.initials: G
authors.lastname: Carstens
authors.forename: María A
authors.initials: MA
authors.lastname: Benavides
authors.forename: Enrique
authors.initials: E
authors.lastname: Suárez
mesh_terms: D001082:Aqueous Humor / Q000378:metabolism; D003315:Cornea / Q000473:pathology / Q000601:surgery*; D065306:Corneal Injuries; D019781:Corneal Topography; D004564:Electrocoagulation / Q000379:methods*; D005131:Eye Injuries / Q000209:etiology* / Q000473:pathology; D006801:Humans; D006956:Hyperopia / Q000601:surgery*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D012029:Refraction, Ocular; D012421:Rupture; D014792:Visual Acuity