Clinical case of the correction of postkeratoplastic astigmatism: LASIK + crosslinking + ICS

    Abstract

    Clinical case of the correction of postkeratoplastic astigmatism: LASIK + crosslinking + ICS

    Demyanchenko S.K., Tereshchenko A.V., Vishnyakova E.N.

    The Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution

    Propose. To carry out the analysis the clinical case of the correction of postkeratoplasticastigmatism for the patient having keratoconus after a penetrating keratoplasty (PK).

    Material and methods. Theretrospective analysis of the refractiveresults of the correction postkeratoplastic astigmatism for the patient having keratoconus.

    Results. PatientM. whowas born in 1983 and having the diagnosis keratoconus was carried out a PKat the OD in 2010. In 10 month safterremoval of sutures, uncorrected visual acuity was 0,3; corrected visual acuity – 0,8. The keratometry for the weak Meridian was 40diopters, the keratometry for the strong Meridian was 44,25diopters. The refractometry was +3; -3,75; 15°.

    In 2013 it noticed of increasing the meaning of keratometry to 41,5-47diopters in the weak and the strong Meridian respectively un corrected visual acuity reduced to 0,2, corrected visual acuity remained at the level 0,8. The operation LASIK with using the microkeratome for the formation of the surface loscut. In the early postoperational period the visual acuityincreasedto0,8 without the correction. In 6 months after the operation itnoticed the regression of the refractive results. The procedure of the ultravioletcrosslinking for the transplant of thecorneawas carried out in 2018. In the postoperational period for 6 month the indicatorsuncorrected visual acuity, corrected visual acuity, the keratometry and the refractometry were stable. In 6 months the implantation of the intrastromal segments into the transplant of the cornea was fulfilled. Purpose of this was the correction of astigmatism. In the post operational period the visual acuity OD increased to 0,7 without the correction. The keratometry reduced to 36,1-43,2diopters.The receiving results are stable in time. The period of observation after the implantation of the cornealsegments is 1 years.

    Conclusion. The refractive effect LASIK at the correction of corneal astigmatism after conducting the PK for patient having the diagnosis keratoconus had a short-time effect (6 month). The additional combined treatment of returnable astigmatism having fulfilled: the cross linking and the implantation of the intrastromalsegments letsstabilize the condition of thecornealtransplant and achieve the high functional results.

    Keywords: keratoconus, postkeratoplastic astigmatism, LASIK, the cross linking, the implantation of the intrastromal corneal segments.