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Wavefront-Guided Photorefractive Keratectomy in the Treatment of High Astigmatism Following Keratoplasty

Sorkin, Nir MD*; Kreimei, Mohammad MBChB, MRes*; Einan-Lifshitz, Adi MD; Mednick, Zale MD, FRCSC*; Belkin, Avner MD*; Chan, Clara C. MD, FRCSC, FACS*; Slomovic, Allan R. MD, FRCSC*; Rootman, David S. MD, FRCSC*

doi: 10.1097/ICO.0000000000001830
Clinical Science

Purpose: To report the outcome of wavefront-guided photorefractive keratectomy (WG-PRK) in the treatment of high astigmatism following keratoplasty.

Methods: A retrospective, interventional analysis including patients with high astigmatism following either penetrating keratoplasty or deep anterior lamellar keratoplasty, who underwent WG-PRK.

Results: Thirteen eyes (7 right eyes) of 12 patients (10 male) aged 35.1 ± 5.9 years were included. Preoperative astigmatism ranged between 3.00 and 5.00 D. Average follow-up time was 14.0 ± 6.2 months. Uncorrected distance visual acuity (UDVA) improved from 0.97 ± 0.58 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent ∼20/187) preoperatively to 0.13 ± 0.15 logMAR (Snellen equivalent ∼20/27) at 6 months and 0.14 ± 0.16 logMAR (Snellen equivalent ∼20/28) at the final follow-up (P = 0.001 and P = 0.002, respectively). UDVA ≥20/40 increased from 1 eye (7.7%) preoperatively to 13 eyes (100%) at 6 months and 12 eyes (92.3%) at the final follow-up (P < 0.001 for both). UDVA ≥20/25 increased from 1 eye (7.7%) preoperatively to 6 eyes (46.2%) at 6 months and at the final follow-up (P = 0.027 for both). Mean astigmatism improved from −3.98 ± 0.75 D to −1.27 ± 0.82 D and −1.40 ± 1.04 at 6 months and at the last follow-up, respectively (P = 0.001 for both). Preoperative astigmatism was ≥3.00 D in all eyes and was reduced to ≤2.50 D in all eyes at 6 months postoperatively, with 7 eyes (63.6%) having ≤1.00 D of astigmatism at both 6 months and the final follow-up.

Conclusions: WG-PRK was safe and effective in the treatment of high and regular postkeratoplasty astigmatism.

*Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; and

Ophthalmology Department, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Correspondence: Nir Sorkin, MD, Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, 399 Bathurst St, 6th Floor East Wing, Reception 1, Toronto, ON M5T 2S8, Canada (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received August 19, 2018

Accepted November 01, 2018

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