Post lasik 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. 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. Lateonset post lasik ectasia with no apparent risk factor except eye rubbing. Corneal ectasia preferred practice pattern ophthalmology. Features and prognosis were evaluated in all patients with ectasia. Eye freedom after lasik, the cornea has been made thinner. She reported that after she underwent lasik, the vision in her left eye was great and had remained. Corneal thickness changes after corneal collagen crosslinking. His uncorrected visual acuity ucva was 66 in the re, 618 in the le, his best spectacle corrected visual. Pentacam hr criteria for curvature change in keratoconus.
The patient is wearing a rigid scleral contact lens. Pressure inside the eye called intraocular pressure iop, which pushes on the back surface. Original article high myopia as a risk factor for post. New filters for lasik screening new studies with innovative indices are allowing surgeons to catch more risky corneas before surgery. Pdf corneal ectasia after photorefractive keratectomy prk has only been occasionally reported, and its incidence has not been assessed. The appearance and progression of post lasik ectasia are similar to a degenerative disease of the cornea called keratoconus.
Unilateral ectasia after lasik in a patient with abnormal topography but normal tomography emmanuel guilbert, md. Although ectasia is a risk more related to lasik than prk, there are good reasons to choose lasik whenever there are the conditions to perform it safely, according to hersh. Herein, we describe a case of post lasik ectasia with high myopia as the identifiable risk factor. As lasik surgeons, we are all familiar with the potential risks for the development of corneal ectasia after lasik. They are helpful in restoring vision, supporting in corneal healing and improving overall quality of life of complex corneal diseases patients. Corneal ectasia is one of the rare yet potentially devastating complications encountered after refractive surgery including laser in situ keratomileusis lasik and. Request pdf on feb 1, 2003, hani g faraj and others published corneal ectasia after lasik find, read and cite all the research you need on researchgate. Pdf keratoconus and corneal ectasia after lasik perry. Upon completion of this issue, you should be able to. Corneal collagen crosslinking for keratoconus and corneal. Furthermore, it is reported many years after surgery. Dec 18, 2012 corneal ectasia following lasik surgery causes changes in the shape of the cornea and can lead to decreased vision. Treating postlasik ectasia with corneal crosslinking.
Methods eyes with an ectasia risk score of 2 or higher were treated with standard lasik 90. To report the incidence of postoperative ectasia after laser in situ keratomileusis lasik. Keratectasia is one of the most feared and dreaded complications of lasik. Corneal ectasia post lasik complication new treatment info.
If corneal ectasia develops, there are many options available for treatment before an eye becomes a candidate for penetrating keratoplasty pkp. Ectasia after lasik postlasik keratoconus corneal ectasia. Postlasik ectasia may be a new name for an old disease. Corneal crosslinking treats ectasia after refractive surgery. In the early years of performing this procedure, we used anecdotal information to define our criteria for exclusion. Dec 05, 2011 patients presented in this case series however had no recognizable preoperative underlying corneal risk factors for post lasik ectasia.
Risk factors and prognosis for corneal ectasia after lasik. Post lasik ectasia is considered in patients who developed increasing myopia, with or without increasing astigmatism, loss of uncorrected visual acuity, often loss of bestcorrected visual acuity, with keratometric steepening, with or without central and. The condition is due to the weakening of the inner layers of the cornea, which occurs during surgery. Corneal ectasia induced by laser in situ keratomileusis ioannis g. Keratoconus and corneal ectasia after lasik 2005 ascrs. Corneal ectasia vision distortion is there a clear solution. The purpose of the registry is to identify risk factors that are not currently known and to serve as a basis for clinical trials in the future, said dr. To evaluate the risk factors for post laser in situ keratomileusis lasik ectasia. Here are links to possibly useful sources of information about postlasik ectasia. Read a sample of postlasik ectasiakeratoconus reports currently on file with the fda. Mar 05, 2014 keratectasia is one of the most feared and dreaded complications of lasik. Ectasia after lasik american academy of ophthalmology. To report the longterm results of corneal collagen crosslinking cxl in ectasia after lasik and photorefractive keratectomy prk.
Definitive evidence that the procedure can reduce the risk of corneal ectasia will only become available a number of years. Late onset corneal ectasia after lasik surgery sciencedirect. Case reports post lasik ectasia treated with intrastromal corneal ring segments and corneal crosslinking kay lam, md, dan b. A registry for reporting cases of ectasia after lasik had its debut recently. Methods the study included 7 patients 2 men and 5 women. Corneal collagen crosslinking for ectasia after lasik and.
Internal pressure from within the eye can cause expansion or distension of the cornea. This practice unfortunately led to several ectactic surprises despite following what we thought were safe guidelines. Postlasik ectasia or corneal ectasia is a rare but serious complication of lasik laser eye surgery. The clinical signs can challenge your detection skillscorneas with subclinical keratoconus are clinically normal in appearance but have subtle irregularities on corneal topography. Corneal ectasia can severely impair vision, especially in the progressive form caused by the inherent structural instability of the cornea.
Eyeworld treating postlasik ectasia with corneal crosslinking. Decreasing vision after laserassisted insitu keratomileusis lasik history of present illness. To report a first case of lenticule addition and corneal crosslinking for postlasik ectasia with associated corneal thinning. Post lasik ectasia risk scoring also has relevance. Five years ago, my team in athens, greece, introduced the concept of performing. Keratoconus and corneal ectasia after lasik request pdf. Glasses and soft contact lenses are ineffective on an eye such as this. Management of corneal ectasia after lasik with phototherapeutic. Patient 1, a 47yearold man, developed corneal ectasia in his right eye 6 months after unilateral hyperopic lasik.
Management of postlasik corneal ectasia with intacs inserts. Unilateral ectasia after lasik in a patient with abnormal docteur. Lasik in a patient with abnormal topography but normal tomo graphic indices. 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. Full text ectasia risk factors in refractive surgery opth. Post surgical ectasia is a condition resembling keratoconus but comes from a different origin. Corneal ectasia is one of the most devastating complications after laser in situ keratomileusis lasik. Thirtymonth results after the treatment of postlasik ectasia with. In my experience, patients that have ectasia for lasik usually develop that fairly quickly, within a year or 2, if its actually caused by the lasik, he explained. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and post lasik ectasia. Over time, the weakened cornea loses its shape and bulges forward, resulting in distorted vision that cannot be corrected with eyeglasses.
Validation of the ectasia risk score system for preoperative laser in situ keratomileusis screening. Corneal collagen crosslinking for corneal ectasia of post. A decade after the introduction of the laser in situ keratomileusislasik technique in refractive surgery, the initial enthusiasm was replaced by skepticism. The fda has full knowledge of the growing epidemic of postlasik ectasia, but they are complicit in failing to warn prospective lasik patients. Its what many practitioners worry abouta postlasik patient comes in with signs of a thinning, bulging cornea. Known risk factors for post lasik corneal ectasia in miami. Deep anterior lamellar keratoplasty in postlaser in situ. A special gas permeable contact or scleral lens will be needed to restore lost vision. Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for. Ideal sources for wikipedia s health content are defined in the guideline wikipedia. Regardless, he said that corneal crosslinking is the proper procedure to perform on somebody who has ectasia. You can see the protrusion of the cornea at the weakest spot ectasia, which results in very distorted vision.
The corneal shape has become more regular, but the patient needs to remain on the drops to keep the effect. Four patients developed bilateral ectasia, and the rest had unilateral ectasia. In their studies, santhiago et al911 provided evidence that a high value of pta, especially 40%, is a relevant factor in the development of postlasik ectasia in eyes with normal preoperative placido diskbased topography, and therefore, pta should be taken into account as a screening parameter for refractive surgery candidates. To evaluate the efficacy of phototherapeutic keratectomy ptk combined with photorefractive keratectomy prk and riboflavin. Postlasik ectasia is a condition similar to keratoconus where the cornea starts to bulge.
This 56yearold woman presented status post bilateral lasik for myopia at an outside institution. Corneal ectasia occurs when the inner layers of your cornea become weak, causing the cornea to change shape, protrude forward and distort your vision. Unilateral ectasia after lasik in a patient with abnormal. Request pdf on nov 1, 2005, perry s binder and others published keratoconus and corneal ectasia after lasik find, read and cite all the research you need on researchgate. Corneal ectasia after photorefractive keratectomy springerlink. Dec 20, 2006 corneal ectasia after photorefractive keratectomy prk has only been occasionally reported, and its incidence has not been assessed. Apr 18, 2012 to evaluate the efficacy and safety of corneal collagen crosslinking cxl to prevent the progression of post laser in situ keratomileusis lasik corneal ectasia. Young patients needing a high correction or who have a high degree of astigmatism and anisometropia may also be. Studies suggest it may occur in roughly one of every 2,000 lasik procedures. Preferred practice pattern guidelines free download available at. Keratoconus and corneal ectasia after lasik 2005 file. We studied a group of patients referred to a universitybased refractive surgery center who developed ectasia after lasik to identify factors that may have.
May 11, 2018 we evaluated clinical safety and longterm efficacy of topographyguided excimer laser enhancement combined with higher variable fluence and pattern refractive cxl as demonstrated in this video. Treating post lasik ectasia with corneal crosslinking by enette ngoei eyeworld contributing editor dr. 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. Post operative clinical issues are events that occur after the surgery and include. Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for possible risk factors such as keratoconus. Postoperative factors may play a role in the pathogenesis of postlasik corneal ectasia. Cxl is a novel treatment to stabilize the progression of both keratoconus and postlasik ectasia. The cases presented, herewith, had late onset postlasik ectasia despite normal preop corneal topography, calculated residual corneal stromal bed thickness of more than 250. Risks factors for developing postlasik corneal ectasia low residual stromal bed thickness.
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. Post lasik ectasia of the cornea is one of the most severe complications of lasik laser in situ keratomileusis. Probability model of the inaccuracy of residual stromal thickness prediction to reduce the risk of ectasia after lasik part i. Dec 15, 2004 a post lasik ectasia patient who was caught early bottom topography. Patient subjective visual function after corneal collagen. Lateonset postlasik ectasia with no apparent risk factor. Results in irregular astigmatism with accompanying blurred andor distorted vision. Easy calculation evaluates postlasik ectasia risk american. This was a retrospective evaluation of clinical data. Read a sample of other types of lasik injury reports currently on file with the fda. 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. Corneal collagen crosslinking for ectasia after lasik and photorefractive keratectomy longterm results olivier richoz, md, 1nikolaos mavrakanas, md, bojan pajic, md, phd,1 farhad hafezi, md, phd1,2 purpose. Mean time to the mean time to the development of ectasia averaged 16.
Post lasik ectasia treatment for post lasik side effects. To identify factors that can lead to corneal ectasia after laser in situ kerato. The main purpose of this study is to report a case series of late onset corneal ectasia following lasik with otherwise no preoperative corneal risk factors. The scan below shows the cornea of a patient who developed ectasia after lasik. Corneal tomographic features of postrefractive surgery ectasia. Ectasia following smallincision lenticule extraction smile. These include eyes that have thin corneas, require high correction, or have worrisome but not frankly contraindicative topography. Materials and methods case report a 39yearold man of middleeastern descent under. Ectatic corneas are both a contraindication and an occasional consequence of lasik.
To identify factors that can lead to corneal ectasia after laser in situ kerato mileusis lasik. Pdf incidence and clinical characteristics of post lasik ectasia. 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. Corneal ectasia induced by laser in situ keratomileusis. 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. Collagen crosslinking has emerged as a promising technique to slow or stop the progression of keratoconus12 as well as postlasik ectasia. Young patients needing a high correction or who have a high degree of astigmatism and anisometropia may also be higher risk.
Because keratoconus may develop in the absence of refractive surgery, the occurrence of ectasia after lasik does not necessarily mean that lasik was a. Factors that have been reported to place an individual at increased risk for developing corneal ectasia after lasik include preoperative topographic abnormality, low residual stromal bed thickness, young age, thin corneas, and high myopia. Pdf keratoconus and corneal ectasia after lasik eric. Eightytwo eyes 54 keratoconus, 28 post lasik ectasia of 65 patients had cxl and were followed for 1 year. Fiftysix eyes 35 keratoconus, 21 ectasia received hypotonic riboflavin before uva light administration, and 26eyes 19 keratoconus, 7ectasia received standard dextran riboflavin solution only. Most eye doctors fell that having a minimum of 250 microns of tissue remaining in the base of the cornea after the laser treatment is important in helping prevent the development of corneal ectasia.
To report a case of unilateral ectasia developing after lasik in a patient with abnormal topography but normal tomographic indices. 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. Corneal ectasia can occur shortly after lasik, small incision lenticule extraction. Ectatic corneal disorders including keratoconus and ectasia after lasik are the second most common indications for keratoplasty, accounting. Laser in situ keratomileusis lasik removes corneal stroma in an area between 6. Preventing ectasia with crosslinking after prk or lasik. The inclusion criteria included age 14 years or older, axial topography consistent with keratoconus or corneal ectasia, an inferiorsuperior ratio greater than 1.
In a prospective, nonrandomized, singlecentre study, cxl was performed in 20 eyes of 11. Ectasia after lasik, corneal postlasik ectasia a state of. Apr 15, 2015 firm up your approach to corneal ectasia. Pdf corneal ectasia after photorefractive keratectomy. Stoneciphers patient returned in 2007 for additional treatment but showed signs of keratoectasia source. Abrams fensterman attorneys at law lasik malpractice.
If you are one of the few people to experience post lasik ectasia, the good news is that new methods are available that may allow your surgeon to. Ectasia after laser in situ keratomileusis sciencedirect. The exact risk for post lasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. In this episode of a state of sight, isaac porter, md explains post lasik. Pressure inside the eye called intraocular pressure iop, which pushes on the back surface of the cornea. Keratectasia has been reported to occur more frequently after retreatments, as seen in. The lasik procedure permanently weakens and thins out the cornea, resulting in progressive changes in the cornea such as steepening or bulging, called ectasia. This focal points issue will help you evaluate patients for corneal ectasia, be aware of the risk factors for corneal ectasia after lasik, perform a variety of diagnostic modalities to screen patients, and manage and treat ectasia. 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. To report a case of unilateral ectasia developing after. The rate of ectasia after lasik is estimated to be about one in 2,000, but this number could be an underestimate due to underreporting and lack of longterm followup after lasik.
1535 362 4 490 511 1070 1481 431 1667 904 1153 1022 892 168 1472 280 34 754 1462 135 239 1229 118 1090 968 199 630 536