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R. Pineda, II, U. Jurkunas, P. C. Gupta; Vector Analysis of Surgical Outcome of LASIK After Conductive Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1986.
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Conductive keratoplasty (CK) is a cornea-steepening procedure currently used for treatment of hyperopic and presbyopic symptoms. For presbyopia, it typically creates monovision with functional visual acuity. The purpose of our study is to present a case-series of patients who were intolerant to the post-CK anisometropia and were treated with laser in-situ keratomileusis (LASIK) to decrease myopia in the near-vision eye.
We reviewed charts of 3 patients who presented with decreased depth perception after CK for presbyopia. All 3 patients underwent LASIK to decrease anisometropia 3 to 9 months after CK. We evaluated LASIK outcomes and performed vector analysis by Holladay-Cravy-Koch method on pre-LASIK and post-LASIK refractive error.
Mean spherical equivalent (SE) of the CK-treated eyes was -2.29 diopters (D) and mean astigmatism was 1.08 D. Two eyes underwent microkeratome-assisted LASIK and 1 eye IntraLasik. The average aim was -0.58 D. Mean SE after LASIK was -0.08 D and mean astigmatism was 0.83 D. Vector analysis showed that LASIK after CK had a tendency to overcorrect total refractive error and to induce mild astigmatism in an unpredictable axis.
To our knowledge, this is the first case-series report of intolerable anisometropia and decreased depth perception after CK. LASIK is an effective procedure to treat CK-induced anisometropia. Vector analysis shows there is a surgically induced astigmatism when performing LASIK after CK. Based on our results, we suggest that creation of the LASIK flap and a subsequent ablation should be performed as a two-step procedure in patients with a previous CK treatment, similar to LASIK after penetrating keratoplasty to improve final refractive outcome.
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