We read with interest and appreciation the response by Drs Updegraff and Slade to our article.1 We are pleased to hear that several investigations are currently under way to assess the efficacy, outcomes, and complications of ALK. We concur with the conclusion that ALK presents a steep learning curve for the inexperienced surgeon. However, both of our patients were operated on by very experienced ALK surgeons. Despite this expertise, the two patients experienced significant irregular astigmatic complications after surgery. In addition, both patients underwent automated keratectomy in the method outlined in recent texts.2 It is true that the complication rate with freeze myopic keratomileusis and manual keratectomy is much higher. As such, these techniques are not widely used.Unfortunately, we do not have follow-up data for these two cases (they sought a second opinion only). We do not know if the corneal haze in case 2
Crews KR, Olson RJ. Complications of Automated Lamellar Keratectomy-Reply. Arch Ophthalmol. 1995;113(9):1092–1093. doi:10.1001/archopht.1995.01100090014003
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