Laser in situ keratomileusis for residual hyperopic astigmatism after conductive keratoplasty

To report a case of laser in situ keratomileusis (LASIK) in a patient with previous conductive keratoplasty.

A 48-year-old man underwent conductive keratoplasty for low hyperopic astigmatism (manifest refraction OD: +2.25 -0.50 x 77 degrees; OS: +2.50 -0.50 x 105 degrees). Three months postoperatively, UCVA was 20/25 and BSCVA was 20/20 in both eyes; manifest refraction OD: -0.25 -0.75 x 110 degrees; OS: +0.75 -0.75 x 50 degrees. Sixteen months after the operation, regression of refractive outcome was (manifest) OD: +1.75 -1.25 x 90 degrees; OS: +2.50 -0.50 x 85 degrees; UCVA was 20/40 in the right eye and 20/63 in the left eye and BSCVA was 20/20 in both eyes. LASIK was performed for hyperopic regression in the left eye using an automated microkeratome (Alcon SKBM, 130-microm plate; Aesculap-Meditec MEL 70 excimer laser).

LASIK was uneventful and no intraoperative or postoperative complications related to the previous conductive keratoplasty procedure or LASIK were observed. Three months after LASIK and 19 months after the initial conductive keratoplasty, the patient's left eye was emmetropic; UCVA was 20/20(-2), BSCVA was 20/20 and manifest refraction was +0.25 -0.25 x 35 degrees. There was a uniform increase in topographical steepening. Visual acuity, refraction and topographic findings remained unchanged at 6 months.

Even though our experience is limited, treatment of hyperopia with LASIK in an eye with refractive regression following previous conductive keratoplasty resulted in a predicted refractive outcome, with no complications, and improvement in visual acuity at 6 months follow-up.