Discussion by Eric D. Donnenfeld, MD

Abstract

Dr. Busin et al have evaluated the effect of performing a hinged lamellar flap on refraction, visual acuity, and corneal topography in postkeratoplasty eyes with high astigmatism. Their data suggest that graft/host wound biomechanics are influenced by the lamellar cut that occurs in laser in situ keratomileusis (LASIK) after penetrating keratoplasty. They note a reduction in refractive sphere and cylinder up to 3 months after formation of the lamellar flap and suggest that LASIK after penetrating keratoplasty be performed as a two-step procedure to improve predictability of results. In addition, some patients may not require excimer laser photoablation because of reduction in cylinder and sphere, which is associated with flap formation.