A major goal of corneal transplantation is to avoid a rejection reaction. Nowadays, with effective immunosuppressants and other medications, we can help minimize the risk of rejection. Another main goal is to achieve good eyesight. Even with easily accepted by the patient graft often shows an irregular astigmatism, which can not be corrected by glasses or contact lenses. For example, many patients with the best possible glasses see only 30% and 80-100% with a special contact lens.
Previously, in cases where the glasses failed and there was still intolerance to contact lenses, another transplant was often performed with all known risks. Today, the excimer laser can be used to increase the regularity of the surface. This has the consequence that:
“Normal” cosmetic laser procedures are based on a scheme that allows high quality and accuracy. The goal is to correct a normal vision defect, for example, three diopters of myopia (“life without glasses”).
The laser surgery after a cornea transplantation, in contrast, represents a reconstructive intervention, which is tailored to the particular eye. There is no standardized procedure and the factors to be adjusted are manifold. It is above all the experience of the surgeon who, like a sculptor, re-models the cornea. Even after the operation, the glasses will remain in any case, but eyesight and image quality increase.
A 34-year-old woman presented with a clear graft, but an irregular astigmatism of more than 11 dioptres and a vision of 10% with glasses. In addition, the patient did not tolerate contact lenses.
We performed a femto-LASIK in conjunction with a re-lift of the LASIK flap after 6 months to massively reduce astigmatism in two procedures. The end result was a significantly improved corneal surface with daytime vision of 100% with a narrow pupil.