LASIK after cornea transplant

[warp]

I have keratoconus and received a cornea transplant a few months ago. The type of transplant I had is know as an Intralase Enhanced Keratoplasty or IEK because an Intralase laser is used to cut the donor button and recipient cavity. The laser cuts a tongue-and-groove type of shape that is supposed to speed healing and ensure a more regular shape.

At any rate, I now have my stitches out and the surgeon has told me I can get Lasik in 3 months if I want it. I'm having trouble making up my mind. I can now see 20/25 with glasses and 20/20 with a hard contact in that eye. But uncorrected I'm still -4.5 diopters and my glasses are ridiculously thick. I'd really like to have uncorrected vision of 20/30 or better, but I don't want to take imprudent risks.

So here are my questions. Has anyone here had LASIK on a transplanted cornea? I have seen a couple of studies showing success rates of old-style LASIK on old-style cornea transplants, but I haven't seen any studies of iLASIK on IEK outcomes. Has anyone else seen or heard of any published or unpublished studies of that specific set of procedures?

[LasikExpert]

Yes, there have been peer-reviewed studies of Lasik after corneal transplant. I have not located any studies regarding Lasik after transplant when the incisions were made with a femtosecond laser rather than with a mechanical blade, but there should not be any difference. There is nothing in the literature that I found to indicate the cornea's healing after a transplant is going to be different depending upon the manner by which the incision was made.

I would, however, discuss with your surgeon, and possibly with a retina specialist, the potential long-term consequence of Lasik after corneal transplant for keratoconus. It is possible, even likely, that the keratoconus will return after several years. Reducing the structural integrity of a healthy cornea with Lasik is predictible and can be performed with a degree of certianty and safety. You don't have that same margin for error with a person who has had a transplant due to keratoconus. At the very least, discuss having PRK rather than Lasik.