1. Femto-Lasik after corneal transplantation
Diane Marinho MD, Sérgio Kwitko MD
The authors have no financial interests to disclose

2. Introduction
Ametropia following successful corneal transplantations can seriously impact patient’s vision.
Many reports show good refractive results in treating ametropias after corneal grafts with LASIK (1,2,3)
Flap complications such as button-hole and free-cap are more often described in LASIK after corneal transplantations specially with mechanical microkeratomes (1)
1. Kwitko S; Marinho DR; Rymer S; Ramos Filho S. Laser in situ keratomileusis after penetrating keratoplasty. J Cataract Refract Surg.  2001; 27(3):374-9
2. Buzard K; Febbraro JL; Fundingsland BR. Laser in situ keratomileusis for the correction of residual ametropia after penetrating keratoplasty. J Cataract Refract Surg.  2004; 30(5):  
3. Kovoor TA; Mohamed E; Cavanagh HD; Bowman RW. Outcomes of LASIK and PRK in previous penetrating corneal transplant recipients. Eye Contact Lens.  2009; 35(5):242-5 

3. Purpose
To demonstrate the feasibility of Femtosecond Laser corneal flaps in corneal grafts, and report the results of a prospective case series of residual refractive errors after corneal transplantation treated with Femto-LASIK

4. Methods Study Design: prospective case series.
44 eyes of 36 patients who have undergone corneal transplantation were submitted to Femto-LASIK to correct residual ametropia:
Tissue-savings aspheric treatment (Technolas Z100) – 35 eyes
Topo-guided treatment (Schwind Amaris 750) – 8 eyes
Wavefront guided treatment (Technolas Z100) – 1 eye
Intralase Laser IFS 150 was used to create 120 µm corneal flaps

5. Methods
Mean time between the corneal graft and the Femto-LASIK was 48.5 months ( months)
All cases had all sutures removed at least 6 months before LASIK
Evaluated criteria:
Refractive spherical and cylindrical components before and 3 months after treatment (subject refraction)
The presence of trans and postoperative complications related to the flap
Statistical analysis was made to compare refractive results before and after the LASIK procedure

6. Results Mean preoperative refraction (range)
Mean postoperative refraction (range)
Myopia (21 eyes)
-3.22 D ± 1.49 D (-0,75 to D)
-0.33 D ± D (-1.50 to D)*
Hyperopia (17 eyes)
+2.30 D ± D (+0.50 to D)
-0.33 D ± D (-0.50 to D)*
Cylinder (44 eyes)
-5.29 D ± D (-1.50 to D)
-1.70 D ± D (plano to D)*
*(p<0,01)

7. Results Mean spherical myopic refraction reduced 89.7%
Mean spherical hyperopic refraction reduced 85.6%
Mean cylinder power reduced 67.8%
Subjective refraction post Femto-Lasik was significantly reduced in all cases (p<0,01).

8. Results Intraoperative complications: 1 case of decentered flap
5 eyes required enhancement for correction of residual ametropia

9. Conclusion
Reduction of ametropias after corneal transplantation can be safely and efficiently corrected by Femto-LASIK