Inadvertent Use of Cornea with Previous LASIK in Deep Lamellar Keratoplasty

Abstract

To report transplantation of a post-laser in situ keratomileusis (LASIK) donor cornea in a deep anterior lamellar keratoplasty (DALK). An 18-year-old male patient with bilateral keratoconus underwent DALK in his right eye. One week postoperatively, the uncorrected visual acuity was 6/24 and the keratometry readings were 36.4/48.6 D in the operated eye. On slit-lamp examination, two interfaces were observed in the corneal stroma. An anterior segment optical coherence tomography (ASOCT; Visante) scan was performed on the operated eye. The ASOCT showed two distinct interfaces, one in the deep corneal stroma close to the Descemet membrane and another interface in the anterior corneal stroma, 225 µm below the surface of the cornea representing the LASIK flap. The central corneal thickness was 498 µm and the residual stromal thickness was between 45 and 52 µm. The records of the 57-year-old male donor who had died of a road traffic accident did not reveal any history of refractive surgery in the past. The patient was informed about the presence of a LASIK flap on his cornea. Because the patient is asymptomatic, a decision was taken to observe instead of exchanging the graft. Our case report highlights transplantation of a donor cornea with previous refractive surgery. With refractive surgery being performed commonly, a careful and specific history should be obtained from the relatives of the deceased. We recommend the incorporation of standard imaging protocols in eye banks for detection of previous refractive surgery in donor corneas.