title: Topographically guided two-step LASIK and standard LASIK in the correction of refractive errors after penetrating keratoplasty.
abstract: OBJECTIVE
  To evaluate in a long-term period the effectiveness and safety of topographically guided two-step laser in situ keratomileusis (LASIK) and standard LASIK technique in the correction of refractive errors after successful penetrating keratoplasty (PKP) for keratoconus.
  
  
  METHODS
  At least 2 years after PKP and 6 months after removal of all sutures, 15 eyes of 15 patients (Group 1; mean manifest refraction spherical equivalent (MRSE) -7.23 D -/+ 3.42 SD) were submitted to standard LASIK and 15 eyes of 15 patients (Group 2; mean MRSE -4.37 D -/+ 1.97 SD) to a topographically guided two-step LASIK procedure (first the flap and at least 2 weeks later the laser ablation). In all cases, a superior hinged corneal flap(160 microm/9.5 mm) was created.
  
  
  RESULTS
  After a follow-up of 36 months, in Group 1 the mean uncorrected visual acuity (UCVA) was 0.51 logarithm of the minimum angle of resolution (logMAR) -/+ 0.41 SD and the mean best-corrected visual acuity (BCVA) was 0.03 logMAR -/+ 0.05 SD, with a mean MRSE of -1.57 D -/+ 2.65 SD. In Group 2, the mean UCVA was 0.28 logMAR -/+ 0.24 SD and the mean BCVA was 0.01 logMAR -/+ 0.03 SD, with a mean MRSE of -0.07 D -/+ 1.00 SD. In both groups, no complications were observed.
  
  
  CONCLUSIONS
  After a long follow-up period, both topographically guided two-step LASIK and standard LASIK could be considered effective and safe tools in the correction of refractive errors after successful PKP for keratoconus.
authors: Eye Clinic, San Salvatore Hospital, University of L'Aquila, L'Aquila - Italy. lspadea@cc.univaq.it
authors: Leopoldo
authors: L
authors: Spadea
authors: Massimo
authors: M
authors: Saviano
authors: Angela
authors: A
authors: Di Gregorio
authors: Domenico
authors: D
authors: Di Lodovico
authors: Fabio
authors: F
authors: De Sanctis
mesh_terms: D000328:Adult; D019781:Corneal Topography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D015948:Keratoplasty, Penetrating; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D013524:Surgical Flaps; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology