Treatment of mild to moderate keratoconus with laser in situ keratomileusis

Purpose: To evaluate the effectiveness, stability, and complications of las er in situ keratomileusis (LASIK) to treat myopic astigmatism in patients w ith keratoconus. Setting: Buzard Eye institute, Las Vegas, Nevada, USA. Methods: This study included 16 eyes of 9 patients who had keratometric and /or clinical evidence of keratoconus. Mean age was 45 years, and refraction was stable for at least 2 years. Two treatment approaches were evaluated. Results: mean preoperative spherical equivalent was -4.23 diopters (D) +/- 2.14 (SD) with a mean steep keratometry of 46.81 +/- 3.07 D. Mean preoperat ive keratometric cylinder was 3.08 +/- 2.22 D. Mean postoperative keratomet ric cylinder was 3.00 +/- 4.78 D and man spherical equivalent, -0.44 +/- 0. 86 D. Mean postoperative steep keratometry was 44.12 +/- 7.17 D. Two eyes l ost 1 line of best corrected visual acuity (BCVA), 1 eye lost 3 lines, and 2 lost 4 lines. Penetrating keratoplasty (PKP) was scheduled in 3 eyes 1 to 2 years after the primary LASIK. Conclusion: The initial visual results appear promising; but longer term re sults revealed regression of the refractive outcome in some cases. Moreover , despite improvement in the postoperative spherical equivalent and uncorre cted visual acuity in most cases, the risk of loss of BCVA and the necessit y of performing PKP in 3 cases lead us not to consider LASIK as a primary s olution for keratoconus. J Cataract Refract Surg 1999; 25:1600-1609 (C) 199 9 ASCRS and ESCRS.