LASIK and arcuate incisions for the treatment of post-penetrating keratoplasty anisometropia and/or astigmatism.
OBJECTIVE
To study the efficacy of Laser In Situ Keratomileusis (LASIK) and Arcuate Keratotomy (AK) for the treatment of anisometropia and/or astigmatism after Penetrating Keratoplasty (PKP) in an attempt to optimize binocular vision.


METHODS
Correction of post-PKP anisometropia and/or astigmatism was considered only when stable refraction was achieved for at least 6 months. Four eyes were treated for anisometropia and astigmatism using the LASIK technique (IN-PRO Gauss Excimer Laser and SKBM Microkeratome). Five eyes were treated with AK to correct post-PKP astigmatism only. The results were evaluated using the following parameters: uncorrected visual acuity (UCVA), best subjective spectacle correction (BSC-VA), corneal uniformity (CU) index and predictive corneal (PC) acuity from the Holladay Diagnostic Summary (HDS) analysis.


RESULTS
Post-PKP anisometropia and astigmatism were treated successfully after primary LASIK in three out of the four cases. One eye needed an additional diode thermal keratoplasty (DTK). Astigmatism post-PKP was treated successfully after primary AK in four of the five cases. One eye needed an additional LASIK.


CONCLUSIONS
AK can be used successfully in cases of low-grade post-PKP astigmatism. LASIK gives better results in cases of post-PKP anisometropia and astigmatism. In order to affine the final results a combination with other refractive techniques such as DTK can be proposed. CU index and PC acuity (EyeSys-HDS analysis) are poor predictive parameters for visual outcome in cases of irregular corneal surfaces as it is often the case after PKP.
Schraepen
P
P
Department of Ophthalmology, University of Antwerp, Edegem. patrick.schraepen@uza.be
Vandorselaer
T
T
Trau
R
R
Tassignon
M J
MJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015858:Anisometropia / Q000209:etiology / Q000601:surgery*; D001251:Astigmatism / Q000209:etiology / Q000601:surgery*; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity