Combined relaxing incisions and epikeratophakia for the correction of aphakia and high postkeratoplasty degree astigmatism

A combined surgical procedure consisting of corneal relaxing incisions and epikeratophakia was used to correct high-degree postkeratoplasty astigmatism and aphakia in two patients. Both patients achieved their final refractive result as soon as 1 month after suture removal (2 and 3 months after surgery, respectively). Keratometric readings showed a reduction of approximately 20.00 diopters in one case and 10.00 D in the other, while the spherical equivalent changed from +10.00 D to +0.50 D in one eye and from +7.50 D to +1.75 D in the other. Spectacle correction was prescribed for both patients. At the last follow-up visit, about 2 years after surgery, these values were unchanged. The main advantage of the combined technique over two separate procedures was that postoperative visual rehabilitation was faster. Equally important was the stability of the refractive result over a long period of time after surgery, as well as the absence of negative effects on the preexisting corneal graft. In spite of the technical complexity of a combined surgical procedure, this approach probably represents the best choice in rare cases such as the ones reported here.