Wound Dehiscence in a Patient With Keratoconus After Penetrating Keratoplastyand LASIK

PURPOSE: To evaluate the safety and efficacy of intracorneal ring segments (ICRS) for high astigmatism after penetrating keratoplasty (PKP). SETTING:METHODS: This retrospective noncomparative study comprised eyes with high post-PKP astigmatism (>4.00 diopters [D]), contact lens intolerance, and a minimum follow-up of 24 months who had ICRS (Kerarings) implantation by mechanical stromal dissection. Corrected distance visual acuity (CDVA), refractive astigmatism, spherical equivalent (SE), surgically induced astigmatism (SIA), central corneal curvature, topographic corneal astigmatism, average corneal power, and complications were assessed. RESULTS:The mean CDVA was statistically significantly better postoperatively (0.23 G 0.21) than preoperatively (0.98 G 0.27) (P Z .007); no eye lost CDVA. The mean refractive astigmatism decreased from 6.17 G 1.12 D to 4.04 G 1.67 D (P Z .068) and the mean SE from À3.17 G 5.48 D to À0.12 G 2.40 D (P Z .34). The mean SIA was 4.55 G 2.83 D. The mean central corneal curvature decreased from 46.28 G 1.73 D to 42.09 G 3.20 D (P<.01); the mean topographic corneal astigmatism, from 7.07 G 2.52 D to 4.48 G 2.00 D (P<.05) and the mean average corneal power from 45.92 G 1.59 D to 41.88 G 3.37 D (P<.01); all decreases were statistically significant. One patient developed deep vascularization in the lower temporal stromal channel that resolved after ICRS removal. One patient reported significant night halos.CONCLUSION: Implantation of ICRS for high post-PKP astigmatism reduced corneal curvature and topographic astigmatism, significantly improving CDVA.

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confidence: 99%

Intrastromal corneal ring segment implantation for high astigmatism after penetrating keratoplasty

Arriola‐Villalobos¹,

Díaz-Valle²,

Güell³

et al. 2009

“…The occurrence of postoperative wound dehiscence, loss of BSCVA (up to 9% losing 2 lines of BSCVA), and increased enhancement rates (up to 39%) compromise the safety of LASIK in postkeratoplasty eyes. 23,24 The recent developments in surface excimer laser ablation are encouraging in that the laser-assisted subepithelial keratectomy (LASEK) technique appears to have a positive impact on preserving corneal clarity while preserving biomechanical integrity. 31,32,34 Therefore, we decided to evaluate this technique of surface ablation in treating postkeratoplasty ametropia.…”

mentioning

confidence: 99%

Topography-guided customized laser-assisted subepithelial keratectomy for the treatment of postkeratoplasty astigmatism

Rajan

O’Brart²,

Patel³

et al. 2006

“…This might be even more of a problem in keratoconus because of the thin host bed. 5 The direction of force resulting in disruption of the graft-host junction probably has a bearing on the area of disruption. Hypothetically, a tangential force would result in strain across the LASIK flap and the graft-host junction but an axial force would result in stress at the graft-host junction, causing its disruption.…”

Section: Discussionmentioning

confidence: 99%

Protective effect of LASIK flap in penetrating keratoplasty following blunt trauma

Canto

Vaddavalli

Yoo

et al. 2011

Penetrating keratoplasty (PKP) often results in large and unpredictable refractive errors following suture removal in the postoperative period. Laser in situ keratomileusis (LASIK) is an effective means of correcting these errors. However, LASIK following PKP is believed to further weaken an already weak graft-host junction and may predispose such eyes to traumatic dehiscence of the graft-host junction. We describe a case in which the LASIK surgery following PKP seemed to benefit the patient by preventing complete dehiscence of the graft-host junction.