Laser in situ keratomileusis to correct refractive errors after keratoplasty

Purpose: To assess the safety and effectiveness of excimer laser in situ ke ratomileusis (LASIK) to correct refractive myopia, astigmatism, or both aft er keratoplasty. Setting: Eye Clinic Day Hospital, Sao Paulo, Brazil. Methods: Twenty-two eyes that had previously had corneal transplantation we re studied. Laser in situ keratomileusis was performed using the Chiron aut omated microkeratome and the VISX Twenty-Twenty B excimer laser. Results: Mean follow-up after LASIK was 10.09 months +/- 3.87 (SD). The sph erical equivalent refraction dropped from -4.55 +/- 3.66 D before LASIK to -0.67 +/- :1.24 D after surgery. At the last examination, 72.7% of patients had a refractive error within +/-1.00 D of emmetropia and 54.5% had uncorr ected visual acuity of 20/40 or better. Vector analysis of astigmatic corre ction showed an index of success of 54.9%. Best spectacle-corrected visual acuity was unchanged in 8 cases, improved in 9, and decreased in 5. Signifi cant endothelial cell loss, keratoplasty wound dehiscence, and other seriou s complications did not develop in any eye. Conclusion: The correction of refractive error with LASIK in postkeratoplas ty patients proved to be safe, effective, and predictable. Further studies with longer follow-up are needed to determine the method's clinical value.