Effect of hinged lamellar keratotomy on postkeratoplasty eyes

Purpose: To evaluate the effect of a hinged lamellar keratotomy on refracti on, vision, and corneal topography of postkeratoplasty eyes with high-degre e astigmatism. Design: Noncomparative, interventional case series. Participants: A hinged lamellar keratotomy was performed on nine eyes of ni ne patients at least 9 months after penetrating keratoplasty and with high- degree astigmatism. All patients were spectacle and contact lens intolerant . Intervention: A superiorly hinged lamellar keratotomy (corneal flap), 160 m um in thickness and 9 mm in diameter, was created on all eyes included in t his study. Each patient was examined 1 day, 1 month, and 3 months after sur gery. Main Outcome Measures: Uncorrected visual acuity, best spectacle-corrected visual acuity, refraction, computerized analysis of corneal topography. Results: At each postoperative examination time, there was a significant re duction in both average spherical equivalent (P<0.05) and average absolute value of astigmatism (P<0.01) over mean preoperative values. The major chan ges were seen as early as 1 day after surgery, but both progression and reg ression of the effect were documented at later postoperative examinations. In all patients best spectacle-corrected acuity was maintained or improved after the procedure. Postoperatively, four patients could be successfully c orrected either with spectacles (n=2) or with gas-permeable contact lenses (n=2). There were no surgical flap or corneal graft complications. Conclusions: Hinged lamellar keratotomy improves vision and refraction of p ostkeratoplasty eyes with high-degree astigmatism. In some cases it may be so effective as to make planned excimer laser treatment unnecessary. Ophtha lmology 2001;108:1845-1851 (C) 2001 by the American Academy of Ophthalmolog y.