Purpose: To determine the safety and effectiveness of laser in situ keratomileusis (LASIK) for visual rehabilitation of residual myopia and astigmatism after penetrating keratoplasty. Design: Prospective, noncomparative case series. Participants: LASIK was performed on 23 eyes of 22 patients unable to wear glasses or contact lenses after penetrating keratoplasty due to anisometropia, high astigmatism, and/or contact lens-intolerance. Methods: All patients underwent LASIK for visual rehabilitation after penetrating keratoplasty. Uncorrected visual acuity and best spectacle-corrected visual acuity, degree of anisometropia, and corneal transplant integrity were recorded before surgery, as well as at 1 month, 3 months, 6 months, and 12 months after LASIK surgery. Results: The mean spherical equivalent before surgery was -7.58 +/- 4.42 diopters (D), which was reduced to -1.09 +/- 2.01 D, -0.79 +/- 1.84 D, -0.77 +/- 1.25 D, and -1.57 +/- 1.20 D, respectively, at 1, 3, 6, and 12 months after LASIK. The mean cylinder before surgery was 3.64 +/- 1.72 D, which was reduced to 1.98 +/- 1.15 D, 1.64 +/- 1.14 D, 1.48 +/- 0.92 D, and 1.29 +/- 1.04 D, respectively, at 1,3, 6, and 12 months after LASIK. Spherical equivalent anisometropia was reduced from a mean of 6.88 +/- 4.4 D to 1.42 +/- 1.05 D at the final examination. Best-corrected visual acuity remained the same or improved in 21 of 23 eyes and decreased by 1 and 3 lines in 2 patients. There were no surgical flap or corneal transplant complications. Conclusions: LASIK is a viable treatment alternative for myopia and astigmatism after penetrating keratoplasty in patients who are contact lens-intolerant, LASIK is more effective in treating myopia than astigmatism after penetrating keratoplasty.
