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Pichaporn Artornsombudh, Yakov Goldich, Noa Avni-Zauberman, Uri Elbaz, Setareh Ziai, David Rootman; Photorefractive keratectomy after deep anterior lamellar keratoplasty. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3123.
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© ARVO (1962-2015); The Authors (2016-present)
To report the efficacy and safety of photorefractive keratectomy (PRK) for the treatment of residual refractive error following deep anterior lamellar keratoplasty (DALK).
All patients that had PRK for residual myopia, hyperopia and astigmatism following DALK between January 2008 to October 2012 were included in this study. Mitomycin C (MMC) was applied in all cases. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, corneal topography, early and late complications were assessed.
The study included 13 eyes of 13 patients. Nine patients were male and four patients were female. Mean age was 41.3 ± 18.4 years (Mean ± SD). The indications for DALK were: keratoconus (7 eyes), post-infectious scar (4 eyes), post-laser scar (1 eye), and post radial keratotomy (1 eye). Six patients underwent intralase enabled DALK (IE-DALK). The mean period between the DALK and PRK was 27.4 ±12.7 months. The preoperative UDVA was 0.88 ± 0.53 logMAR. The preoperative mean CDVA was 0.20 ± 0.18 logMAR and the mean spherical equivalence (SE) was -2.65 ± 5.00 diopters (D). The mean follow up after PRK was 12.5 ± 11.7 months. At the final visit, the mean UDVA was improved to 0.23 ± 0.25 logMAR (P = 0.001). The mean CDVA was 0.17 ± 0.22 logMAR (P = 0.57), and the mean final SE was -0.05 ± 1.41 D (P = 0.069). Astigmatism tended to be decreased from -3.27 ± 1.76 D preoperatively to -0.94 ± 0.49 D postoperatively (P=0.001). UDVA improved more than two lines in 11 eyes (84.6%). One eye (7.7%) had one line improvement of UDVA and one eye (7.7%) had no improvement. All eyes had complete epithelization within 5 days after procedure. Mild corneal haze without significant visual reduction was presented in 4 eyes (30.8%). One eye had corneal epithelial rejection at 6 months after PRK with MMC which resolved after treatment with topical steroids.
Using PRK with MMC for the treatment of residual refractive error after DALK lead to improvement in uncorrected visual acuity and can be considered as an acceptable treatment modality to improve quality of vision following DALK.
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