title: Combined intrastromal astigmatic keratotomy and laser in situ keratomileusis flap followed by photoablation to correct post-penetrating keratoplasty ametropia and high astigmatism: One-year follow-up.
abstract: OBJECTIVE
  To evaluate a new technique combining intrastromal astigmatic keratotomy (AK) with a laser in situ keratomileusis (LASIK) flap followed by excimer laser photoablation to correct post-penetrating keratoplasty (PKP) high astigmatism and ametropia.
  
  
  METHODS
  Kasr El Aini Hospital, Cairo University, Cairo, Egypt.
  
  
  METHODS
  Prospective interventional uncontrolled case series.
  
  
  METHODS
  Patients with post-PKP high astigmatism and ametropia had paired intrastromal AK with LASIK flap using the M2 microkeratome followed 2 to 3 months later by excimer laser photoablation. The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), mean refractive spherical equivalent (SE), and mean cylinder after each step and at the 1-year follow-up.
  
  
  RESULTS
  The study comprised 20 eyes (20 patients). All parameters were significantly improved in all patients by the last follow-up visit. The mean UDVA improved from 1.07 logMAR ± 0.2 (SD) preoperatively to 0.23 ± 0.18 logMAR (P < .001), the mean CDVA improved from 0.79 ± 0.18 logMAR to 0.12 ± 0.12 logMAR (P < .001), the mean refractive SE improved from -5.04 ± 2.62 diopters (D) to -1.47 ± 1.32 D (P = .001), and the mean cylinder reduced from -5.39 ± 0.98 D to -1.05 ± 0.71 D (P < .001). The mean correction index was 0.84 ± 0.10, and the mean flattening index was 0.83 ± 0.10. Thirty-five percent of cases developed microperforations, and 15% developed epithelial ingrowth.
  
  
  CONCLUSIONS
  This combined approach allowed for the correction of high astigmatism and ametropia following PKP; however, epithelial ingrowth requiring intervention is a complication to be considered.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From Kasr El Aini Hospital, Cairo University, Cairo, Egypt.
authors.forename: Riad B
authors.initials: RB
authors.lastname: Shalash
authors.affiliation: From Kasr El Aini Hospital, Cairo University, Cairo, Egypt. Electronic address: melshazly75@hotmail.com.
authors.forename: Malak I
authors.initials: MI
authors.lastname: Elshazly
authors.affiliation: From Kasr El Aini Hospital, Cairo University, Cairo, Egypt.
authors.forename: Marwa M
authors.initials: MM
authors.lastname: Salama
mesh_terms: D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D012030:Refractive Errors / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013524:Surgical Flaps; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult