Lasik over Transplant, now dry and irregular

This is a photo of an eye that underwent corneal transplant surgery (due to keratoconus) over 20 years ago. 10 years later LASIK surgery was performed on the transplanted cornea. In this photo, a special dye was used to highlight the defects on the ocular surface. Look carefully and you can see 2 concentric circles one within the other on the cornea. The smaller circle is the transplanted cornea. The irregularities in the periphery of the corneal transplant are due to the suturing that was done during the transplant surgery. The outer concentric ring is the edge of the LASIK flap. The geographic areas seen in this photo are due to the dry “hills and valleys” along the corneal surface. In all my years of practice I have never seen LASIK performed on a corneal transplant and I do not believe that it is the “standard of care”. For over 20 years this patient did not have functional vision with this eye. This eye was recently fit with a scleral lens which for the first time in years is allowing this patient to see clearly and comfortably once again.