Corneal ectasia induced by laser in situ keratomileusis. Late onset corneal ectasia after lasik surgery sciencedirect. The clinical onset of keratoectasia can occur months or even years after the surgery. Post lasik ectasia of the cornea is one of the most severe complications of lasik laser in situ keratomileusis. The exact risk for post lasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. The guest edited thematic issues are published free of charge. A longterm study article pdf available in clinical ophthalmology 61. Ectasiawhether postlasik or keratoconushas always been an unwelcome occurrence. Corneal ectasia vision distortion is there a clear solution. Ectasia after lasik american academy of ophthalmology. This appears to be an unfortunate case of post lasik ectasia in a patient who is a confirmed highrisk eye rubber. Easy calculation evaluates postlasik ectasia risk american. 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.
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. Download fulltext pdf download fulltext pdf corneal ectasia after myopic laser in situ keratomileusis. Dec 20, 2006 corneal ectasia after photorefractive keratectomy prk has only been occasionally reported, and its incidence has not been assessed. Managing and predicting ectasia research continues to reveal more about the efficacy of recently developed options for treating this devastating condition. Late onset corneal ectasia after lasik surgery core. This 56yearold woman presented status post bilateral lasik for myopia at an outside institution. Dec 18, 2012 corneal ectasia following lasik surgery causes changes in the shape of the cornea and can lead to decreased vision.
The medical literature contains reports of late onset ectasia occuring several years after lasik. As lasik surgeons, we are all familiar with the potential risks for the development of corneal ectasia after lasik. Regardless, he said that corneal crosslinking is the proper procedure to perform on somebody who has ectasia. Results in irregular astigmatism with accompanying blurred andor distorted vision. My visual acuity in this eye also became very poor. Risk profiles of ectasia after keratorefractive surgery ncbi nih. 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. Clinical grading of post lasik ectasia related to visual limitation and predictive factors for vision loss article pdf available in journal of cataract and refractive surgery 3810.
Thirtymonth results after the treatment of postlasik ectasia with. A medline search for lasik and ectasia yielded 21 relevant articles published before may 2003 n 86 eyes, 59 patients. Give the changes in the magnification and minification changes induced there is moderate miscalculation on part of the scheimpflug system. Corneal ectasia induced by laser in situ keratomileusis ioannis g. Postlaser in situ keratomileusis lasik corneal ectasia is one of the most feared complications of refractive surgery. Newer treatment modalities have been developed to tackle this rare, yet devastating complication of refractive surgery. Consent for offlabel therapeutic use for postlasik. Although few patients with normal corneal topography develop post lasik ectasia, this surprise complication remains one of the most feared in laser refractive surgery, thanks to its potential to cause visual catastrophe. 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. Postoperative factors may play a role in the pathogenesis of postlasik corneal ectasia. Studies suggest it may occur in roughly one of every 2,000 lasik procedures. Article information, pdf download for characterization of the effect of.
I eventually found out that the laser surgery had caused postlasik ectasia, which is a form of keratoconus where the cornea thins. Postoperative corneal ectasia has been estimated to occur in 0. Post surgical ectasia is a condition resembling keratoconus but comes from a different origin. Ectasia is a particularly insidious complication of lasik. Ectasia after lasik postlasik keratoconus corneal ectasia. Ectasia after lasik, corneal postlasik ectasia a state of. Known risk factors for post lasik corneal ectasia in miami. Corneal ectasia post lasik complication new treatment info. Post lasik ectasia management ascrs 2018 laservision clinical and research institute, athens, greece. With all lasik surgeries, the prevention of postoperative ectasia through careful preoperative screening is of paramount importance. Relevant factors in refractive surgery screening include.
Our equipment generates a 3dimensional topography of the post lasik eye. The appearance and progression of post lasik ectasia are similar to a degenerative disease of the cornea called keratoconus. 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. To identify factors that can lead to corneal ectasia after laser in situ kerato. Characteristics of corneal ectasia after lasik for myopia. Patients with forme fruste keratoconus have a high risk for developing iatrogenic ectasia after lasik 11. Letter from a patient that developed keratoconus after lasik. Management of post laser in situ keratomileusis ectasia with simultaneous topography guided photorefractive keratectomy and collagen crosslinking. The patient below was a 18 before lasik, meaning that an extraordinary amount of tissue was removed in an attempt to flatten the cornea correct the patients vision. Download dr agarwals textbook on corneal topography pdf.
Post lasik ectasia is a condition similar to keratoconus where the cornea starts to bulge. Features and prognosis were evaluated in all patients with ectasia. To evaluate the risk factors for post laser in situ keratomileusis lasik ectasia. Corneal ectasia occurs when the inner layers of your cornea become weak, causing the cornea to change shape, protrude forward and distort your vision. 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. The cases presented, herewith, had late onset postlasik ectasia despite normal preop corneal topography, calculated residual corneal stromal bed thickness of more than 250. This practice unfortunately led to several ectactic surprises despite following what we thought were safe guidelines. Upon completion of this issue, you should be able to. Pdf clinical grading of postlasik ectasia related to. Avoiding an ectasia upsurge ectasia after lasik was at one time considered a. Internal pressure from within the eye can cause expansion or distension of the cornea. Risk factors for ectasia after lasik include irregular preop corneal astigmatism and thin post op corneal thickness under the flap. Keratoconus and corneal ectasia after lasik request pdf. In these post lasik ectasia patients, the spherical equivalent was corrected better with two segments compared to single segment implantation.
Eyeworld treating postlasik ectasia with corneal crosslinking. However in 2011 i started to notice my vision was deteriorating and i had developed a great deal of ghosting and starbursts, particularly in the right eye. Risks factors for developing post lasik corneal ectasia low residual stromal bed thickness. Characterization of the effect of intracorneal ring segment in corneal. They are helpful in restoring vision, supporting in corneal healing and improving overall quality of life of complex corneal diseases patients.
A comparison group n 103 eyes, 63 patients was selected from a clinicbased sample of successful lasik patients with 12 months of followup after treatment. Histopathology, ultrastructure, and corneal physiology. Pressure inside the eye called intraocular pressure iop, which pushes on the back surface. Corneal ectasia corneal ectasia a clearer understanding of vision distortion. Post lasik ectasia treatment for post lasik side effects. 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. A special gas permeable contact or scleral lens will be needed to restore lost vision. 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.
To report late onset corneal ectasia following myopic lasik. She reported that after she underwent lasik, the vision in her left eye was great and had remained. Pdf characterization of the effect of intracorneal ring. In this episode of a state of sight, isaac porter, md explains post lasik. Eye freedom after lasik, the cornea has been made thinner. Decreasing vision after laserassisted insitu keratomileusis lasik history of present illness. The lasik procedure permanently weakens and thins out the cornea, resulting in progressive changes in the cornea such as steepening or bulging, called ectasia. Amin ashrafzadeh, md post lasik ectasia evaluated with. Risk profiles of ectasia after keratorefractive surgery. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and post lasik ectasia.
Incidence, risk factors, and treatment for ectasia, keratoconus after lasik. Management of post laser keratomileusis ectasia with. Eyeworld getting schooled on pta for ectasia prevention. A registry for reporting cases of ectasia after lasik had its debut recently. In the above cases of native keratoconus there was excellent correlation, but post lasik ectasia introduces new orders as does the case of post myopic lasik. William trattler, director of cornea at the center for excellence in eye care in miami, florida. Photographs, topographies, and videos of patients with ectasia after lasik. In the early years of performing this procedure, we used anecdotal information to define our criteria for exclusion.
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