Visual rehabilitation after a
keratoplasty is often compromised due to high amounts of residual
astigmatism. Femtosecond
laser-assisted astigmatic keratotomy (FLAK) is gaining popularity in decreasing this
astigmatism. Though one set of two incisions suffices in most cases, sometimes the treatment proves insufficient and additional treatment is required. This case series evaluates the outcomes in patients who underwent two consecutive FLAK sets to correct post-
keratoplasty residual
astigmatism. All repeated FLAK cases performed on post-
keratoplasty eyes were reviewed in a high-volume clinic as a non-comparative retrospective case series. The data extracted include the procedure parameters, time between procedures, refraction including sphere,
astigmatism, spherical equivalent (SE), and uncorrected and best-spectacle-corrected distance visual acuity (UDVA, BSDVA, respectively). Eleven eyes of eleven patients aged 25.5 ± 10 treated with more than one FLAK procedure were identified. The average follow-up time was 6 months after the first FLAK and 24 ± 10 months after the second. The second FLAK was performed six months after the first. The preoperative mean
astigmatism was -9.59 ± 2.36 D. At the final follow-up, the mean
astigmatism decreased to -5.38 ± 1.79 D (p = 0.001). Repeated FLAK procedures achieved a significant and stable reduction of
astigmatism in post-
keratoplasty eyes. This procedure shows safety and effectivity in these complex eyes and may prevent the need for a further
keratoplasty.