Combined intrastromal astigmatic keratotomy and laser in situ keratomileusis flap  followed by photoablation to  correct post-penetrating keratoplasty @entity2516 and high XXXX : One-year follow-up.

@entity940 @entity1 @entity2543 @entity2516
PURPOSE: To evaluate a new technique combining intrastromal astigmatic keratotomy (AK) with a laser in situ keratomileusis (LASIK) flap followed by excimer laser photoablation to correct post-penetrating keratoplasty (PKP) high @entity940 and @entity2516 . SETTING: Kasr El Aini Hospital, Cairo University, Cairo, Egypt. DESIGN: Prospective interventional uncontrolled case series. METHODS: @entity1 with post-PKP high @entity940 and @entity2516 had paired intrastromal AK with LASIK flap using the M2 microkeratome followed 2 to 3 months later by excimer laser photoablation. The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), mean refractive spherical equivalent (SE), and mean cylinder after each step and at the 1-year follow-up. RESULTS: The study comprised 20 eyes (20 @entity1 ). All parameters were significantly improved in all @entity1 by the last follow-up visit.  The mean UDVA improved from 1.07 logMAR    0.2 (SD) preoperatively to 0.23    0.18  logMAR (P < .001), the mean CDVA improved from 0.79    0.18 logMAR to 0.12    0.12  logMAR (P < .001), the mean refractive SE improved from -5.04    2.62 diopters (D) to -1.47    1.32 D (P = .001), and the mean cylinder reduced from -5.39    0.98 D to -1.05    0.71 D (P < .001). The mean correction index was 0.84    0.10, and the mean flattening index was 0.83     0.10. Thirty-five percent of cases developed microperforations, and 15% developed @entity2543 . CONCLUSION: This combined approach allowed for the correction of high @entity940 and @entity2516 following PKP; however, @entity2543 requiring intervention is a complication to be considered. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
