To evaluate and compare the efficacy, predictability, and safety of LASIK in the correction of primary and secondary mixed astigmatism after previous LASIK surgery.

Retrospective, comparative case series.

The retrospective study included 118 eyes having LASIK with the LADARVison 4000 excimer laser (Alcon Surgical, Orlando, Florida) to correct mixed astigmatism. The eyes were divided into two groups: in group A (n = 64), LASIK was for primary mixed astigmatism and in group B (n = 54), LASIK was for secondary mixed astigmatism. Mean follow-up was 10.6 ± 5.90 months.

Overall, the postoperative UCVA was 20/20 in 51% of eyes and 20/40 or better in 97% of eyes at the last visit. The mean refractive cylinder was −2.18 ± 0.94 D preoperatively and −0.56 ± 0.56 D postoperatively. Sixty-one percent of eyes had a refractive cylinder of 0.50 D or less. One eye lost 2 lines of BSCVA (0.8%). None of the eyes had postoperative BSCVA worse than 20/25. The difference of preoperative cylinder was significant between group A and group B (P = .000). However, there was no statistical difference of postoperative refraction and UCVA between these two groups. At 12 months, the mean vector magnitude achieved was 93% of intended cylinder correction with a mean angle of error of −3.0 ± 16 degrees.

LASIK is a safe, effective, and predictable procedure to treat both primary and secondary mixed astigmatism. Nomogram adjustment with spherical and astigmatism components individually may improve refractive outcomes.