Cornea Cases
Title:
Correction of post keratoplasty refractive error by 2 step femto LASIK
Case Report Details
First Author: H.Elnashar EGYPT
Co Author(s):
Abstract Details
Purpose:
to show the efficacy of using 2 step femto lasik after penetrating keratoplasty for patient with advanced keratoconus to correct the post operative refraction after suture removal
Setting:
memorial institute for ophthalmic research
Report of case or case series:
a case of bilateral kc more advanced in rt eye , i did pkp for this eye 2 years ago and after suture removal after 10 months from operation the refraction was +3.50/-9.00x115 and BCVA was 0.2 by +2.50/-7.00x115 .the patient cannot tolerate glasses due to high refraction so, i thought to do lasik for this eye as pentacam showed irregular surface of cornea with good corneal thickness .so, i decided to do femtolasik in 2 step approach .the first step to create flap only to cut all adhesion between anterior surface of cornea and stroma as these adhesion affect refraction and topography of corneal surface , the 2nd step is to apply excimer laser depend on new refraction after 2 months from 1st step. the creation of flap in theses cases is a difficult and long procedure as the adhesion between graft and bed not cutted completely by femto laser and need manual dissection which is really difficult (as shown in video) after 2 months the refraction of patient change from +3.50/-9.00x115 pre creation of flap to +0.50/-5.50x120 post creation of flap (big change in refraction) . so , i applied excimer lasr after 2 months after elevate the flap easily this time and used the following refraction plano / - 5.00 x120 . the post operative refraction was +0.25/-0.75 x126 and unaided visual acuity was 0.7 partial.
Conclusions/Take Home Message:
1) the use of femtolasik in correction of post keratoplasty is a safe and effective method 2)the idea of doing operation on 2 steps is a great idea as there is big difference in refraction after the creation of the flap 3) the adhesion between graft and bed make the operation really a challenge as it cannot be cutted completely by femtolaser and need manual dissection
