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Post-keratoplasty patients’ visual acuity can be severely limited by ametropia. Irregular astigmatisms are frequently encountered in these patients and is commonly associated with high degrees of hyperopia or myopia. This systematic review investigates the safety and efficacy of laser refractive surgery for post keratoplasty vision correction. Thirty-one studies with 683 participants (732 eyes) enrolled in this review. Mean astigmatism improved significantly (MD = -2.70, 95%CI, -3.13 to -2.28, p < 0.0001). As well as Mean spherical equivalent (MD = -3.35, 95%CI, -3.92 to -2.78, p < 0.0001). from 586 participants 5.8% lost two or more lines of CDVA after treatment. The proportion of eyes with 20/40 UCVA or better was reported and the percentage was 46.79% overall. Laser refractive procedures (LASIK or PRK or T-PRK) on eyes with corneal transplantation were found to be relatively safe and effective. Our systematic review shows there is improvement in all outcomes. Main adverse effects were haze for PRK and epithelial ingrowth for LASIK.

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