Rate of ectasia and incidence of irregular topography in patients with unidentified preoperative risk factors undergoing femtosecond laserassisted lasik majid moshirfar,1 jared g smedley,2 valliammai muthappan,1 allison jarsted,3 erik m ostler1 1john a moran eye center, university of utah, salt lake city, ut, usa. Postlasik corneal ectasia is a rare but a serious complication which leads to decreased visual acuity. Postoperative factors may play a role in the pathogenesis of postlasik corneal ectasia. Its what many practitioners worry abouta postlasik patient comes in with signs of a thinning, bulging cornea. A special gas permeable contact or scleral lens will be needed to restore lost vision. High order aberration outcomes of corneal collagen crosslinking in eyes with keratoconus and postlasik ectasia abstract purpose. In this episode of a state of sight, isaac porter, md explains postlasik. Risk profiles of ectasia after keratorefractive surgery. They are helpful in restoring vision, supporting in corneal healing and improving overall quality of life of complex corneal diseases patients. Management of unpredictable postprk corneal ectasia with intacs. 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. Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for.
Thirtymonth results after the treatment of postlasik ectasia with. Ten eyes of seven patients developed postlasik ectasia. Corneal collagen crosslinking for corneal ectasia of post. Regardless, he said that corneal crosslinking is the proper procedure to perform on somebody who has ectasia. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and postlasik ectasia. Along with this condition comes a steady deterioration in the patients vision. To evaluate the efficacy of phototherapeutic keratectomy ptk combined with photorefractive keratectomy prk and riboflavin. My visual acuity in this eye also became very poor. Decreasing vision after laserassisted insitu keratomileusis lasik history of present illness. Ectasia prevalence can be decreased by determining risk factors which lead to postlasik corneal ectasia. Management of postlasik corneal ectasia with intacs inserts. She reported that after she underwent lasik, the vision in her left eye was great and had remained. Corneal ectasia induced by laser in situ keratomileusis ioannis g. Upon completion of this issue, you should be able to.
Postlaser in situ keratomileusis ectasia touchophthalmology. Corneal ectasia following lasik surgery causes changes in the shape of the cornea and can lead to decreased vision. 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. Article as pdf 221 kb article as epub print this article. Late onset corneal ectasia after lasik surgery sciencedirect. I used intacs to treat keratoconus for more than 10 years, and patients were thrilled with the change in their visual function. The cases presented, herewith, had late onset postlasik ectasia despite normal preop corneal topography, calculated residual corneal stromal bed thickness of more than 250. To evaluate the efficacy and safety of corneal collagen crosslinking cxl to prevent the progression of postlaser in situ keratomileusis lasik corneal ectasia. The appearance and progression of postlasik ectasia are similar to a degenerative disease of the cornea called keratoconus. 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. This 56yearold woman presented status post bilateral lasik for myopia at an outside institution. Internal pressure from within the eye can cause expansion or distension of the cornea.
Corneal ectasia after photorefractive keratectomy prk has only been occasionally reported, and its incidence has not been assessed. Decreasing vision after laserassisted insitu keratomileusis lasik. Ectasia following smallincision lenticule extraction smile. Even though the results are encouraging, concern still exists regarding the longterm effect of such an approach for the management of postlasik ectasia.
Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for possible risk factors such as keratoconus. Postsurgical ectasia is a condition resembling keratoconus but comes from a different origin. If corneal ectasia develops, there are many options available for treatment before an eye. Probability model of the inaccuracy of residual stromal thickness prediction to reduce the risk of ectasia after lasik part i. 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. Known risk factors for postlasik corneal ectasia in miami. This study was designed to evaluate efficacy and stability of corneal collagen crosslinking cxl in halting the progression of postlaser in situ keratomileusis lasik ectasia and provide longterm followup results with an average of 80mo. In a prospective, nonrandomized, singlecentre study, cxl was performed in 20 eyes of 11 patients who had lasik for myopic astigmatism and subsequently developed keratectasia. Main outcome measures were uncorrected distance visual. Corneal ectasia pvr prose treatment post lasik problems. Patients with postlasik ectasia were treated with cxl between december 2007 and january 2012.
Results in irregular astigmatism with accompanying blurred andor distorted vision. Management of corneal ectasia after lasik with phototherapeutic. Journal of refractive surgery volume 21 novemberdecember 2005. Corneal ectasia vision distortion is there a clear solution. Ectasia after lasik, corneal postlasik ectasia a state. 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. I eventually found out that the laser surgery had caused postlasik ectasia, which is a form of keratoconus where the cornea thins.
William trattler, director of cornea at the center for excellence in eye care in miami, florida. In a retrospective, noncomparative case series, incidence of corneal ectasia was evaluated in a personal consecutive 6453case series of myopic prk with a minimum followup of 18 months. A registry for reporting cases of ectasia after lasik had its debut recently. Ectasia after lasik american academy of ophthalmology.
Keratectasia is one of the most feared and dreaded complications of lasik. 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. 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. To identify factors that can lead to corneal ectasia after laser in situ kerato mileusis lasik. This suggests that the higher risk of developing ectasia after lasik compared with prk. In a prospective, nonrandomized, singlecentre study, cxl was performed in 20 eyes of 11. Conclusions intracorneal ring segments implantation improved uncorrected visual acuity and best spectaclecorrected visual acuity in patients with postlasik ectasia. Ideal sources for wikipedia s health content are defined in the guideline wikipedia.
Keratoconus and corneal ectasia after lasik citeseerx. To evaluate the risk factors for postlaser in situ keratomileusis lasik ectasia. Long term efficacy and stability of corneal collagen cross. Such a patient clearly has a case of postlasik ectasia. Keratoconus and corneal ectasia after lasik 2005 file. The exact risk for postlasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. 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. Eye freedom after lasik, the cornea has been made thinner. To evaluate the effect of riboflavin and ultravioletainduced corneal collagen crosslinking cxl on high order aberrations hoa up to. Treating postlasik ectasia with corneal crosslinking. High order aberration outcomes of corneal collagen.
Keratoconus and corneal ectasia after lasik 2005 ascrs. Validation of the ectasia risk score system for preoperative laser in situ keratomileusis screening. The original lasik surgeon diagnosed ectasia and recommended the placement of intacs addition technology, des plaines, il. Letter from a patient that developed keratoconus after lasik surgery. A retrospective nonrandomized study involved preoperative lasik data from 23 post lasik ectasia cases and 266 stable lasik follow up 12 months.
I became involved in the crosslinking technique out of desperation, trying to manage postlasik ectasia patients, he explains. Topographical features and surgical parameters of those patients were evaluated. Postlasik ectasia may be a new name for an old disease. To evaluate the efficacy and safety of corneal collagen crosslinking cxl to prevent the progression of post laser in situ keratomileusis lasik corneal ectasia. We evaluated clinical safety and longterm efficacy of topographyguided excimer laser enhancement combined with higher variable fluence and pattern refractive cxl as. Rate of ectasia and incidence of irregular topography in. Letter from a patient that developed keratoconus after. Photographs, topographies, and videos of patients with ectasia after lasik. 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. Patient had corneal refractive stability for five years after lasik. The advent of refractive surgery allowed for great advances in the understanding.
Corneal ectasia occurs when the inner layers of your cornea become weak, causing the cornea to change shape, protrude forward and distort your vision. To report the incidence of postoperative ectasia after laser in situ keratomileusis lasik. Treatment options are available with keratoplasty as the last resort. Preventing ectasia with crosslinking after prk or lasik.
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 risk factors. Features and prognosis were evaluated in all patients with. Postlasik ectasia can theoretically be explained by mechanical factors, as described by comaish and lawless. 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. Pdf incidence and clinical characteristics of post lasik ectasia. Confusing keratoconus and post lasik ectasia 15 nov 2012 eye practice. Full text ectasia risk factors in refractive surgery opth. Five years ago, my team in athens, greece, introduced the concept of performing. One of the supposed risks and complications of getting laserassisted in situ keratomileusis lasik surgery is corneal thinning called post lasik ectasia.
The trip database provides clinical publications about evidence. Pressure inside the eye called intraocular pressure iop, which pushes on the back surface. Corneal ectasia post lasik complication new treatment info. Postlaser in situ keratomileusis lasik corneal ectasia is one of the most feared complications of refractive surgery. Corneal ectasia induced by laser in situ keratomileusis. The incidence of postoperative ectasia has been estimated to range from 0. One study found that all patients who develop iatrogenic ectasia post lasik had at least one predictable risk factor. A newly proposed metric, percentage tissue altered, has been reported to be a robust indicator for post lasik ectasia risk calculation. Orbscan of the right and left eyes of a patient before lasik.
Risks factors for developing postlasik corneal ectasia low residual stromal bed thickness. Ectasia after laser in situ keratomileusis sciencedirect. Studies suggest it may occur in roughly one of every 2,000 lasik procedures. Managing corneal ectasia prior to keratoplasty oculus pentacam. Corneal crosslinking treats ectasia after refractive surgery.
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