Wound dehiscence in a patient with keratoconus after penetrating keratoplasty and LASIK.

Residual refractive error often complicates penetrating keratoplasty (PKP) and can be treated surgically in patients who are contact lens intolerant. Both photorefractive keratectomy and laser in situ keratomileusis (LASIK) have been used to reduce postoperative myopia and astigmatism following PKP. Reported complications of LASIK following PKP include irregular astigmatism, photoablation decentration, stromal bed hemorrhage, obstruction of the microkeratome path by graft sutures, corneal perforation, flap dislocation, melts, slippage, paracentral perforation, or buttonhole. Keratoconus has been described as a contraindication to LASIK due to corneal instability attributed to the exceedingly thin residual stromal bed produced by the lamellar dissection, but several studies have documented successful LASIK following PKP in patients with keratoconus. We report herein a case of wound dehiscence following LASIK in a patient with post-PKP keratoconus, the first such report to our knowledge.