Corneal ectasia after myopic lasik has been well described in the literature14. Risk factors and prognosis for corneal ectasia after lasik. Ectatic corneal disorders including keratoconus and ectasia after lasik are the second most common indications for keratoplasty, accounting for about 15% of corneal transplants performed in the. Over time, the weakened cornea loses its shape and bulges forward, resulting in distorted vision that cannot be corrected with eyeglasses. Management of corneal ectasia after lasik with combined, sameday, topography. Keratectasia has been reported to occur more frequently after retreatments, as seen in the left eye of patient 4 in our study. This may indicate that post prk ectasia is diagnosed later than post lasik ectasia, although this cannot be determined conclusively, due to the small sample size of post prk ectasia cases and the large variability of diagnosis time. Unilateral ectasia after lasik in a patient with abnormal. The inclusion criteria included age 14 years or older, axial topography consistent with keratoconus or corneal ectasia, an inferiorsuperior ratio greater than 1.
Keratoconus and corneal ectasia after lasik 2005 file. In 2005 i had lasik eye surgery performed on both eyes. This 56yearold woman presented status post bilateral lasik for myopia at an outside institution. Nov 01, 2005 ectatic corneal disorders including keratoconus and ectasia after lasik are the second most common indications for keratoplasty, accounting for about 15% of corneal transplants performed in the. The appearance and progression of postlasik ectasia are similar to a degenerative disease of the cornea called keratoconus. Several advances in intracorneal ring segment design have been made recently. Pdf clinical grading of postlasik ectasia related to. Herein, we describe a case of post lasik ectasia with high myopia as the identifiable risk factor. Preoperative factors can usually be identified to guide proper patient selection and treatment.
Case reports post lasik ectasia treated with intrastromal corneal ring segments and corneal crosslinking kay lam, md, dan b. Corneal thickness changes after corneal collagen crosslinking. Pdf incidence and clinical characteristics of post lasik ectasia. Cornea and refractive surgery subspecialty practice. Pentacam hr criteria for curvature change in keratoconus. New filters for lasik screening new studies with innovative indices are allowing surgeons to catch more risky corneas before surgery. In this prospective, non randomised clinical study 22 eyes of 15 patients 6 female, 9 male with a history of lasik and the development of iatrogenic keratectasia after lasik were included. To report a case of unilateral ectasia developing after lasik in a patient with abnormal topography but normal tomographic indices. Studies suggest it may occur in roughly one of every 2,000 lasik procedures. Fiftysix eyes 35 keratoconus, 21 ectasia received hypotonic riboflavin before uva light administration, and 26eyes 19 keratoconus, 7ectasia received standard dextran riboflavin solution only. Eyeworld treating postlasik ectasia with corneal crosslinking. Cxl is a novel treatment to stabilize the progression of both keratoconus and post lasik ectasia. To report the incidence of postoperative ectasia after laser in situ keratomileusis lasik. Binder ps, lindstrom rl, stulting rd, donnenfeld e, wu h, mcdonnell p, rabinowitz y.
I was diagnosed by a very experienced cornea specialist with post lasik ectasia in. Postlaser in situ keratomileusis ectasia touchophthalmology. Corneal collagen crosslinking in postlasik keratectasia. Postlasik ectasia or corneal ectasia is a rare but serious complication of lasik laser eye surgery.
Postlasik ectasia is a condition similar to keratoconus where the cornea starts to bulge forwards at a variable time after lasik, prk, or smile corneal laser eye surgery. Letter from a patient that developed keratoconus after lasik. Easy calculation evaluates postlasik ectasia risk american. Five years ago, my team in athens, greece, introduced the concept of performing prophylactic, highfluence cxl after lasik. The study included 30 eyes from 16 patients with bilateral normal preoperative placidobased corneal topography that developed ectasia after lasik ectasia group and 174 eyes from 88 consecutive. Preventing ectasia with crosslinking after prk or lasik. Lateonset postlasik ectasia with no apparent risk factor. When ectasia began to rear its ugly head several years ago in postop lasik patients, surgeons scrambled for better ways to screen candidates who might be susceptible to this disastrous corneal thinning.
To identify factors that can lead to corneal ectasia after laser in situ kerato mileusis lasik. Patient subjective visual function after corneal collagen. Original article high myopia as a risk factor for postlasik. Intacs are now available in smaller diameter ring inner diameter of 6 mm with a thickness of 0. Stoneciphers patient returned in 2007 for additional treatment but showed signs of keratoectasia source. Methods the study included 7 patients 2 men and 5 women. These types of refractive surgeries are more likely. The green arrow points to the location of an rk scar and ectasia, and the red arrow points to the location of the flap separation.
She felt that the vision in her right eye initially was decent, but never as good as the left eye. The crosssectional scan below shows a cornea with postrk, postlasik ectasia. Frimmel,c and samir melki, md, phda,d author affiliations. It is more likely to occur following lasik, radial keratotomy rk, or astigmatic keratotomy ak surgery. Keratoconus and corneal ectasia after lasik 2005 ascrs. Mean time to the mean time to the development of ectasia averaged 16.
Ectasia after lasik postlasik keratoconus corneal ectasia. Refractive surgery getting schooled on pta for ectasia prevention by maxine lipner eyeworld senior contributing writer prevalence of individual variables investigated as possible ectasia risk factors in eyes with post lasik ectasia with normal preop corneal topography. Although few patients with normal corneal topography develop postlasik ectasia, this surprise complication remains one of the most feared in laser refractive surgery, thanks to its potential to cause visual catastrophe. Corneal ectatic disorders or corneal ectasia are a group of uncommon, noninflammatory, eye disorders characterised by bilateral thinning of the central, paracentral, or peripheral cornea. Intacs implantation with sequential collagen crosslinking treatment in postoperative lasik ectasia. Ectatic corneas are both a contraindication and an occasional consequence of lasik. Routine lasik and cxl corneal ectasia after laser refractive surgery is rare. When this happens, the remaining corneal tissue, or residual corneal bed, ends up being too thin, in turn weakening the cornea and allowing it to bulge under normal eye pressure. If you experienced ectasia keratoconus after lasik, you should file a medwatch report online with the fda. In 2009 my left eye rapidly deteriorated as i lost my vision and felt pain grow stronger by the day. Original article high myopia as a risk factor for post. Post operative clinical issues are events that occur after the surgery and include. Abrams fensterman attorneys at law lasik malpractice. Eye freedom after lasik, the cornea has been made thinner.
The exact risk for postlasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. Clinical grading of post lasik ectasia related to visual limitation and predictive factors for vision loss. Escrs survey reveals risk factors for postlasik ectasia. Eyeworld getting schooled on pta for ectasia prevention. Managing corneal ectasia prior to keratoplasty expert rev. This suggests that the higher risk of developing ectasia after lasik compared with prk may be related to some corneal biomechanical. Treating postlasik ectasia with corneal crosslinking. Pdf risk factors for post lasik ectasia yuri mercado. While this works out at about one case of ectasia for every 5,000 lasik procedures, it is still very much a feared complication because of its potentially devastating impact. Corneal ectasia vision distortion is there a clear solution. To report a first case of lenticule addition and corneal crosslinking for postlasik ectasia with associated corneal thinning. Ectasia after lasik american academy of ophthalmology.
Definitive evidence that the procedure can reduce the risk of corneal ectasia will only become available a number of years. Internal pressure from within the eye can cause expansion or distension of the cornea. Treating postlasik ectasia with corneal crosslinking by enette ngoei eyeworld contributing editor dr. Brooks, md, steven greenstein, md, kristen fry, od, ms, peter s. We studied a group of patients referred to a universitybased refractive surgery center who developed ectasia after lasik to identify factors that may have. While only 180 cases of postlasik corneal ectasia have been described in the published literature many of which are unexplained experts believe that. Corneal ectasia induced by laser in situ keratomileusis ioannis g. Corneal ectasia induced by laser in situ keratomileusis. A special gas permeable contact or scleral lens will be needed to restore lost vision.
On clinical evaluation, the difference in preoperative evaluation of femtosecond lasik cases is spending careful attention to any superficial corneal scars. The condition is due to the weakening of the inner layers of the cornea, which occurs during surgery. Keratoconus and corneal ectasia after lasik request pdf. In an attempt to clarify some of the issues surrounding postlasik ectasia, a committee of cornea and refractive surgeons assembled by the international society of refractive surgery american academy of ophthalmology and the american society of cataract and refractive surgery issued a consensus report in november 2005. Ectasia was diagnosed according to pallikaris et al. It is common that patients who are contact lens wearersand they are the majority of people who decide to undergo lasik for. Four patients developed bilateral ectasia, and the rest had unilateral ectasia. Experts believe that postlasik ectasia is caused by removing too much corneal tissue during lasik surgery. After lasik, the cornea appears to be mechanically weakened by the tissue ablation and the lamellar cut,12 but it is not known to what degree this contributes to the cause and mechanism of post lasik ectasia. Methods eyes with an ectasia risk score of 2 or higher were treated with standard lasik 90. Unilateral ectasia after lasik in a patient with abnormal topography but normal tomography emmanuel guilbert, md. Lateonset post lasik ectasia with no apparent risk factor except eye rubbing. Corneal ectasia post lasik complication new treatment info. This led the authors to conclude that the femtosecond technology may be a better procedure for implanting intracorneal ring segements in postlasik ectasia.
Deep anterior lamellar keratoplasty in postlaser in situ. Thirtymonth results after the treatment of postlasik ectasia with. Post lasik ectasia is the most feared complication following lasik, occurring in majority of cases within 1 year of surgery. Apr 15, 2015 firm up your approach to corneal ectasia. Then i began to notice that the sight in my left eye was beginning to degrade. The patient below developed postlasik corneal ectasia.
She reported that after she underwent lasik, the vision in her left eye was great and had remained good. Original article high myopia as a risk factor for post lasik ectasia. Treating post lasik ectasia with corneal crosslinking by enette ngoei eyeworld contributing editor dr. Patient subjective visual function after corneal collagen crosslinking for keratoconus and corneal ectasia nneka o. Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for possible risk factors such as keratoconus. Insights on ectasia surgeons are having to deal with lasik cases that develop ectasia despite the lack of the usual preop warning signs of keratoconus. The inclusion criteria included age 14 years or older, axial topography consistent with keratoconus or corneal ectasia, inferiorsuperior ratio greater than 1. Clinical sciences management of postlasik corneal ectasia. Postrefractive surgery ectasia is a loss of corneal integrity leading to corneal warpage that often resembles keratoconus. Corneal ectatic disorders or corneal ectasia are a group of uncommon, noninflammatory, eye disorders characterised by bilateral thinning of the central, paracentral, or peripheral cornea keratoconus, a progressive, noninflammatory, bilateral, asymmetric disease, characterized by paraxial stromal thinning and weakening that leads to corneal surface distortion. They are helpful in restoring vision, supporting in corneal healing and improving overall quality of life of complex corneal diseases patients. Postlasik ectasia is a condition similar to keratoconus where the cornea starts to bulge. Lasik laser refractive surgery lasik is a common procedure to treat nearsightedness, farsightedness and astigmatism. Eightytwo eyes 54 keratoconus, 28 post lasik ectasia of 65 patients had cxl and were followed for 1 year.
Alternatively, you may call fda at 1800fda1088 to report by telephone, download the paper form and either fax it to 1800fda0178 or mail it using the postagepaid addressed form, or download the medwatcher mobile app for reporting lasik problems to the fda using. In this case report, we describe and analyze a post lasik ectasia case in one eye which was diagnosed after 11 years without any risk. Altogether, the rate of firstyear ectasia diagnosis in prk patients was 31%. With lasik, patients can achieve 2020 vision or better. Because keratoconus may develop in the absence of refractive surgery, the occurrence of ectasia after lasik does not necessarily mean that lasik was a. There are numerous reports of corneal ectasia that developed after lasik in myopic eyes, occurring in most of cases 1 year after surgery, 4,5. Pvr prose treatment for corneal ectasia pvr prose treatment prosthetic replacement of the ocular surface ecosystem uses fabricated and custom designed prosthetic devices depending upon individual cases.1389 409 243 668 755 1494 1372 689 1546 434 745 424 594 1060 605 432 177 957 1243 1125 904 1201 1244 405 1174 592 1070 1306 108 997 618 622 491 392 366 1283 876 1346 833 1023 1000