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J. I. McNeill; Two-Stage LASIK With Relaxing Incisions Under the Corneal Flap Reduces High Astigmatism After Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5365.
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© ARVO (1962-2015); The Authors (2016-present)
To combine LASIK with relaxing incisions under the corneal flap in a two-stage sequence to test the reliability of reducing large amounts of astigmatism that commonly occur after penetrating keratoplasty.
A prospective case series of penetrating keratoplasty patients was selected who had 5 diopters or more of stable topographic astigmatism following removal of all corneal transplant sutures. Stage 1 treatment: Following microkeratome formation and lifting of the LASIK flap, 450 micron deep intrastromal relaxing incisions were placed parallel to the transplant wound, centered on the steep meridian. Stage 2 treatment: When the topography was stable, the excimer laser was used to treat the full refractive error similar to standard LASIK enhancement.
Nineteen patients met the selection criteria. Topographically measured corneal transplant astigmatism before Stage 1 treatment averaged 9.13 ± 2.92 (SD) diopters (range=5.75-16.13). After topographic stabilization following the Stage 1 treatment of cutting the LASIK flap and placing corneal transplant relaxing incisions under the flap, the average topographic astigmatism was reduced by 45% to 4.98 ± 3.14 diopters (range=1.13-13.21, p<0.001). Three patients were satisfied with their optically corrected result following Stage 1 (best spectacle corrected visual acuity (BSCVA): 20/20, 20/25, and 20/50), and did not proceed to Stage 2 treatment with the excimer laser. The remaining sixteen patients completed Stage 2 treatment of their full refractive error with the excimer laser. Two patients each had 2 and 3 excimer laser treatments. Topographic corneal transplant astigmatism following Stage 2 averaged 2.37 ± 1.60 diopters (range=0.22-5.96, p (pre-Stage 1) <0.001, p (post-Stage 1) <0.001), for a total reduction of 74%. The final BSCVA of all patients completing the Stage 2 treatment ranged from 20/20 to 20/40.
Combining LASIK with penetrating keratoplasty intrastromal relaxing incisions under the LASIK flap in a 2-stage process reliably reduced high topographic astigmatism by an average of 74% with all patients showing improvement.
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