Femto-LASIK alongside PK

Femto-LASIK is a safe and effective means of reducing postoperative refractive error in patients who have previously undergone penetrating keratoplasty procedures, according to Luca Terracciano MD. “Despite a clear corneal graft, the presence of high refractive defects can often lead to an unsatisfactory visual outcome after keratoplasty procedures. Non-surgical options such as spectacles and contact lenses may not be able to effectively correct a very high defect,” he said Dr Terracciano’s study included 10 eyes of 10 patients who underwent keratoconus full-thickness keratoplasty. The WaveLight Refractive Suite (Alcon), incorporating the Wavelight EX500 excimer laser and the Wavelight FS200 femtosecond laser, was used to create a 130μm lamellar flap with a superior hinge. The flap diameter average was 0.2mm smaller than graft-host junction and was centred inside the donor button. After flap creation, it was lifted and excimer laser ablation for refractive correction was performed. At 12 months’ postoperative evaluation, all patients showed a significant improvement in their uncorrected visual acuity as well as in the cylindrical ametropia and best-corrected visual acuity. No statistically significant difference was observed for postoperative spherical ametropia. “We found this procedure to be safe and free of complications. Creating the flap with the femtosecond laser and performing excimer laser ablation within the corneal graft limits without involving the graft-host junction minimises the risk of rejection and allows good results in correction of aberrations,” he told delegates attending the 37th Congress of the ESCRS in Paris. Dr Terracciano, Department of Translational Surgery and Medicine at the University of Florence, Italy, said that despite the overall viability of the approach, the correction of high ametropia after corneal transplantation is affected by technical and anatomical limits that do not always allow satisfactory results to be achieved. “The procedure works better with a small amount of ametropia: in other cases, attention must be taken in defining the refractive results you may achieve and a different approach should be considered when only corneal-laser therapy is not the best option – you can think about combined corneal/intraocular surgery trying to regularise the cornea before cataract surgery; toric or piggyback IOLs are another possible alternative, as is a combined corneal procedure such as astigmatic keratotomy/relaxing incisions and femto-LASIK” he said. Summing up, Dr Terracciano said that correcting the preoperative manifest refractive error with femto-LASIK led to a significant improvement in uncorrected visual acuity without surgical complications and confirms the effectiveness and safety of femto-LASIK treatment for post PK residual refractive errors particularly in patients with low spherical and cylindrical defects as previously suggested in literature. The reduction of astigmatism may allow improved contact lens or spectacle fitting in order to achieve best-corrected binocular visual acuity. Luca Terracciano: terracciano.oculista@gmail.com

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