Combined post-keratoplasty LASIK/AK to treat high astigmatism

Refractive unpredictability and postoperative astigmatism are common complications following penetrating keratoplasty [1-5]. High astigmatism may result in decreased visual acuity, anisometropia, image distortion, and monocular diplopia, thus challenging the visual rehabilitation of patients [1]. Spectacle correction or soft contact lenses are used to manage small amounts of cylinder, while rigid gas permeable lenses are effective for higher levels of regular astigmatism or in the presence of irregular astigmatism [1]. However, contact lenses may not be successful for all patients due to a variety of factors including corneal abnormalities, dry eye, lid abnormalities, or contact lens intolerance. Therefore, when conservative methods fail, other refractive treatments for post-keratoplasty astigmatism are needed.