Rekeratoplasty for the Correction of Refractive Status Due to Post-LASIK Donor Graft

We report a case of cataract-combined penetrating keratoplasty that required rekeratoplasty for refractive status because of the inadvertent use of a cornea from a donor who had undergone LASIK surgery. The case presents the use of perioperative visualization, anterior segment optic coherence tomography, and histopathologic confirmation. A 63-year-old female patient with leukoma and cataract in the left eye underwent combined cataract surgery and penetrating keratoplasty. During surgery, a jelly-like layer extending a few millimeters in diameter was observed around the lenticule. In addition, the graft was noticed to separate into 2 distinct layers, which were attributed to previous LASIK surgery. Optic coherence tomography of the postoperative anterior segment of the donor cornea also revealed a LASIK flap layer. Postoperative corneal topography displayed a power distribution of 46.8, 36.9, and 22.1 D at the 1.0-, 3.0-, and 7.0-mm corneal zones, respectively, and the best visual acuity did not improve. For this reason, rekeratoplasty was performed. Histopathologic evaluation of the excised button confirmed the presence of a LASIK flap. To the best of our knowledge, this case is the first report of penetrating keratoplasty that required rekeratoplasty due to refractive status. Perioperative discovery of a jelly-like layer due to a LASIK flap has also not been previously described. As the number of refractive surgeries increases, reliable, low-cost, and simple screening methods must be developed to more successfully detect postrefractive surgery tissue in the donor cornea supply.