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LASIK improves near, distance visual acuity after DALK for keratoconus
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LASIK proved successful in correcting refractive error in eyes that had undergone deep anterior lamellar keratoplasty for keratoconus, a study found.
“Correcting the preoperative manifest refractive error with LASIK led to an improvement in the [corrected distance visual acuity] without surgical complications,” the study authors said. “The treatment seems to be associated with acceptable residual refractive errors; thus, it represents a treatment option in post-DALK keratoconus patients.”
The retrospective study included 12 eyes of 11 patients with a mean age of 30.5 years who underwent deep anterior lamellar keratoplasty (DALK) and subsequent LASIK; the mean interval between DALK and LASIK was 18.33 months.
Mean post-LASIK follow-up was 11.17 months.
Before surgery, mean logMAR uncorrected distance visual acuity (UDVA) was 0.21; mean corrected distance visual acuity (CDVA) was 0.73. Postoperatively, mean logMAR UDVA improved to 0.73 and mean CDVA improved to 0.98. All eyes attained postoperative UDVA better than 0.5.
Six eyes gained three lines of CDVA and six eyes gained two lines. No eyes lost lines of CDVA. Eleven eyes were within 2 D of manifest spherical equivalent, eight eyes were within 1 D, and five eyes were within 0.50 D. Postoperative UDVA equaled or exceeded preoperative CDVA in eight eyes (66.67%).
Mean manifest refraction, auto kerato-refractometer spherical error, topography and auto kerato-refractometer keratometry readings decreased significantly at 1 month (P < .01), but later changes were insignificant.
Mean central corneal thickness diminished significantly, from 611.67 μm preoperatively to 534 μm postoperatively (P < .01).
No intraoperative or postoperative complications were reported, the authors said.
Perspective
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John A. Hovanesian, MD, FACS
Most cornea specialists today perform PRK with mitomycin C to treat residual refractive error after DALK or penetrating keratoplasty, but it is reassuring to see that a small group of DALK patients in this study did fairly well when LASIK was used for this purpose. LASIK can be challenging in these eyes. Unless the flap is made small and is confined to the graft itself, the LASIK flap can intersect with the graft edge, potentially causing a free cap or the loss of a crescent of flap tissue from the surrounding host tissue. With a femtosecond laser-created flap, however, this complication is unlikely. Those of us who have come to trust DALK as the preferred transplant method for keratoconus will benefit from the new information introduced by this nice study.
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J Cataract Refract Surg. 2012;38(6):1020-1027.
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