The cases presented, herewith, had late onset postlasik ectasia despite normal preop corneal topography, calculated residual corneal stromal bed thickness of more than 250. Treating post lasik ectasia with corneal crosslinking by enette ngoei eyeworld contributing editor dr. In this episode of a state of sight, isaac porter, md explains post lasik. If corneal ectasia develops, there are many options available for treatment before an eye becomes a candidate for penetrating keratoplasty pkp.
Studies suggest it may occur in roughly one of every 2,000 lasik procedures. Postsurgical ectasia is a condition resembling keratoconus but comes from a different origin. After conducting a metaanalysis of published results from 1998 to 2005 related to post lasik ectasia, the researchers found that, compared with controls, ectasia cases had abnormal preoperative topographies 35. Eyeworld treating postlasik ectasia with corneal crosslinking. 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. Eyeworld getting schooled on pta for ectasia prevention. However, it is often difficult to convince post lasik patients with earlystage ectasia to undergo this procedure because of slow and painful recovery periods16. These have included partial transplant techniques, and more recently using. Risk of post prk ectasia was calculated using the ectasia risk score system erss for laser in situ keratomileusis lasik patients. The clinical onset of keratoectasia can occur months or even years after the surgery. 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. Corneal ectasia after excimer laser refractive surgery most likely represents a disruption of biomechanical integrity and a subsequent reduction below the threshold required to maintain corneal shape and curvature.
Preferred practice pattern guidelines free download available at. A 33year old gentleman developed ectasia 12 years following an uneventful lasik. 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. Features and prognosis were evaluated in all patients with. Corneal ectasia after photorefractive keratectomy prk has only been occasionally reported, and its incidence has not been assessed. The cornea is too thin from the amount of corneal tissue that was removed with the laser procedure or a prior corneal disease and begins to protrude forward. Combining the impact from the procedure with an advanced corneal. Corneal ectasia also called kerectasia or keratectasia is an infrequent but serious complication of lasik surgery. Corneal ectasia can occur shortly after lasik and photorefractive. A press release issued by avedro, a company that sells a drugdevice treatment for post lasik ectasia, states, the incidence of corneal ectasia following refractive surgery lasik is estimated to affect approximately 160,000 patients in the united states, qualifying it as an orphan disease. Corneal ectasia or corneal ectatic disorders is a group of disorders that include uncommon, noninflammatory eye disorders. Postlasik ectasia was considered as increasing myopia with or without developing astigmatism, reduction of uncorrected visual acuity. Ectasia following smallincision lenticule extraction smile.
Corneal ectasia after excimer laser corneal refractive surgery, or postoperative ectasia, is a progressive steepening and thinning of the cornea, with increasing myopia and astigmatism, loss of uncorrected distance visual acuity, and usually loss of corrected distance. 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 postlasik ectasia with normal preop corneal topography. While accomplishing new studies to combine tomographic. Risk profiles of ectasia after keratorefractive surgery. Dec 18, 2012 corneal ectasia following lasik surgery causes changes in the shape of the cornea and can lead to decreased vision. Crosslinking is the goldstandard treatment for progressive corneal ectasia. Ectasia after refractive surgery is a progressive increase in myopia, with or. Newer treatment modalities have been developed to tackle this rare, yet devastating complication of refractive surgery. Postlasik corneal ectasia is a noninflammatory process that results in deformation of the cornea along with thinning and biome chanical weakening110. The appearance and progression of post lasik ectasia are similar to a degenerative disease of the cornea called keratoconus. Pdf corneal ectasia after photorefractive keratectomy. Corneal ectasia pvr prose treatment post lasik problems. Thirtymonth results after the treatment of postlasik ectasia with.
Postlasik ectasia is a condition similar to keratoconus where the cornea starts to bulge. Keratoconus and corneal ectasia after lasik request pdf. Post surgical ectasia is a condition resembling keratoconus but comes from a different origin. Postlasik ectasia causes experts believe that postlasik ectasia is caused by removing too much corneal tissue during lasik surgery. If the laser removes too much tissue during lasik or the flap made too deep, the structure of the cornea can be weakened. Because keratoconus may develop in the absence of refractive surgery, the occurrence of ectasia after lasik does not necessarily mean that lasik was a. Dec 20, 2006 corneal ectasia after photorefractive keratectomy prk has only been occasionally reported, and its incidence has not been assessed. Results in irregular astigmatism with accompanying blurred andor distorted vision.
Pdf thirtymonth results after the treatment of postlasik ectasia. Corneal ectasia induced by laser in situ keratomileusis. Photographs, topographies, and videos of patients with ectasia after lasik. Histopathologic studies suggest that intermellar and interfibrillar biomechanical slippage occurs when the cornea becomes ectatic after lasik or prk in the post operative stressbearing regions. In spite of these improvements, no statistically significant improvements were.
Preventing ectasia with crosslinking after prk or lasik prophylactic crosslinking stabilizes the cornea and promotes the success of laser refractive surgery. Laser procedures carry different biomechanical effects, due to different flap cut parameters. As a result, combining corneal collagen crosslinking with lasik lasik. Amin ashrafzadeh, md post lasik ectasia evaluated with. Some researchers have focused on preventing corneal deepithelialization so as to achieve efficient and recovery from corneal intrastromal crosslinking in post lasik ectasia. High order aberration outcomes of corneal collagen crosslinking in eyes with keratoconus and post lasik ectasia. Apr 15, 2015 iatrogenic ectasias occur primarily through post corneal refractive surgery. Characteristics of corneal ectasia after lasik for myopia. The exact risk for post lasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. Incidence, risk factors, and treatment for ectasia, keratoconus after lasik. To evaluate the risk factors for postlaser in situ keratomileusis lasik ectasia.
Known risk factors for post lasik corneal ectasia in miami. 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. We also attempted to evaluate the relative contributions of these factors to the development of ectasia following refractive surgery. Corneal crosslinking treats ectasia after refractive surgery. She reported that after she underwent lasik, the vision in her left eye was great and had remained.
Ectasiawhether postlasik or keratoconushas always been an unwelcome occurrence. Ectasia after lasik american academy of ophthalmology. Fortunately, new options have proliferated in recent years. Internal pressure from within the eye can cause expansion or distension of the cornea. Corneal ectasia is a severe complication occurring after lasik surgery. Pdf corneal collagen crosslinking for ectasia after excimer. To identify factors that can lead to corneal ectasia after laser in situ kerato mileusis lasik.
Post refractive surgery ectasia is a loss of corneal integrity leading to corneal warpage that often resembles keratoconus. Pdf to evaluate the 1year results of corneal collagen crosslinking cxl in eyes with postoperative excimer laser refractive surgery corneal. The combined intervention improved udva from 2070 to 2040 and. Reported rates of postlasik ectasia in eyes without identified risk factors have declined in recent years. Pdf keratoconus and corneal ectasia after lasik perry. Postlasik ectasia post surgical complication of lasik eye refractive surgery. 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. The combined intervention improved udva from 2070 to 2040 and cdva from 2040 to 2020 with 2 years followup. Managing corneal ectasia prior to keratoplasty oculus pentacam.
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. Combining cxl and prk has been proposed to stabilize the cornea while providing. Preventing ectasia with crosslinking after prk or lasik. 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. 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.
Sep 08, 2007 ectasiawhether postlasik or keratoconushas always been an unwelcome occurrence. 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. Treating postlasik ectasia with corneal crosslinking. Postlasik ectasia is an iatrogenic condition, where changes of the. Postlasik ectasia was described first by seiler et al. Pvr prose treatment for corneal ectasia pvr prose treatment prosthetic replacement of the ocular surface ecosystem uses.
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. Treating postlasik ectasia with corneal crosslinking by enette ngoei eyeworld contributing editor dr. Corneal ectasia can occur shortly after lasik, small incision lenticule. Once the diagnosis of corneal ectasia after lasik was confirmed see the following section, written informed consent was obtained from all the patients. Preventing ectasia with crosslinking after prk or lasik cataract. Post lasik ectasia was considered as increasing myopia with or without developing astigmatism, reduction of uncorrected visual acuity. The appearance and progression of postlasik ectasia are similar to a degenerative disease of the cornea called keratoconus.
Ectasia after laser in situ keratomileusis sciencedirect. To identify factors that can lead to corneal ectasia after laser in situ keratomileusis lasik. The patient had had lasik performed elsewhere and subsequently developed ectasia. The exact risk for postlasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. They are helpful in restoring vision, supporting in corneal healing and improving overall quality of life of complex corneal diseases patients. If corneal ectasia develops, there are many options available for treatment before an eye. Factors that put patients at risk are abnormal corneal topography, very high spectacle correction, a very thin cornea, a very steep cornea and younger age.
A medline search for lasik and ectasia yielded 21 relevant articles published before may 2003 n 86 eyes, 59 patients. 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. Corneal ectasia vision distortion is there a clear solution. Full text ectasia risk factors in refractive surgery opth.
Easy calculation evaluates postlasik ectasia risk american. 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. Corneal ectasia after photorefractive keratectomy springerlink. Dec 05, 2011 the cases presented, herewith, had late onset postlasik ectasia despite normal preop corneal topography, calculated residual corneal stromal bed thickness of more than 250. Late onset corneal ectasia after lasik surgery sciencedirect. Late onset corneal ectasia after lasik surgery article pdf available in saudi journal of ophthalmology 253. High order aberration outcomes of corneal collagen. Post lasik ectasia, ectasia, lasik, visante, visante omni, pentacam. High order aberration outcomes of corneal collagen crosslinking in eyes with keratoconus and postlasik ectasia. Postlasik ectasia is a multifactoral entity associated with thin corneas and residual stromal beds, enhancements, and preoperative corneal abnormalties. Management of corneal ectasia after lasik with combined, same. It is more likely to occur following lasik, radial keratotomy rk, or astigmatic keratotomy ak surgery.
These types of refractive surgeries are more likely to cause ectasia because of how they disrupt the cornea. Decreasing vision after laserassisted insitu keratomileusis lasik history of present illness. In this episode of a state of sight, isaac porter, md explains postlasik. However, it is often difficult to convince postlasik. Forme fruste keratoconus, genetic predisposition to keratoconus, low residual stromal bed thickness through high myopia, thin preoperative cornea, or thick lasik flap, and irregular corneal topography have. Corneal ectasia induced by laser in situ keratomileusis ioannis g. Iatrogenic ectasias occur primarily through postcorneal refractive surgery. Ectasia after lasik postlasik keratoconus corneal ectasia. Risks factors for developing postlasik corneal ectasia low residual stromal bed thickness.
Postoperatively, the corneal power and elevation were stable with a remarkable improvement in corneal thickness, and the lenticule had merged. Postlasik ectasia or corneal ectasia is a rare but serious complication of lasik laser eye surgery. May 11, 2018 a 33year old gentleman developed ectasia 12 years following an uneventful lasik. Management of corneal ectasia after lasik with combined. Known risk factors for postlasik corneal ectasia in miami. 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.
Corneal ectasia preferred practice pattern ophthalmology. Over time, the weakened cornea loses its shape and bulges forward, resulting in distorted vision that cannot be corrected with eyeglasses. This 56yearold woman presented status post bilateral lasik for myopia at an outside institution. Ectasia following smallincision lenticule extraction. Corneal ectasia remains an enigmatic, potentially devastating complication of laser in situ keratomileusis lasik. Randleman and perezstraziota discuss the causes of, risk factors for, and management of ectasia. Combining cxl and prk has been proposed to stabilize the cornea while. Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for. Early detection of ectasia is critical to maximize ultimate visual acuity when this complication does occur. Ectasia after lasik, corneal postlasik ectasia a state of. I have a patient whos considering lasik, but someone she knows experienced postlasik ectasia. Eye freedom after lasik, the cornea has been made thinner. 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.
Despite the establishment and validation of risk factors to screen patients prior to refractive surgery, corneal ectasia still develops in a small percentage of people. Corneal ectasia post lasik complication new treatment info. Post lasik ectasia 34 yo male with myopic astigmatism central corneal thickness 498, 495 flap thickness 98, 95 max ablation depth 95, 92 pta. Traditional options for treatment, most notably penetrating keratoplasty, can salvage vision but have significant downsides. Patients with corneal ectasia after lasik from the department of ophthalmology, provincial hospital affiliated to shandong university, jinan, china, were included in the study. Add to that the fact that around 90% of those with post lasik ectasia cases also exhibited signs of genetic keratoconus. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and post lasik ectasia. Undertheflap crosslinking and lasik in early ectasia with.
Topographical features and surgical parameters of those patients were evaluated. Laser in situ keratomileusis lasik removes corneal stroma in an area between 6. The condition is due to the weakening of the inner layers of the cornea, which occurs during surgery. Although exact prevalence of postlasik ectasia is not known, reported prevalence rates change between 0. Post laserassisted in situ keratomileusis ectasia semantic scholar. Risk factors and prognosis for corneal ectasia after lasik. Successful cases of lasik are reported from short term followup periods but the incidence of late onset corneal ectasia following lasik is not known. Durrie also put the number of those with post lasik ectasia without possessing genetic keratoconus at around 1 to 2% of the total cases. Histopathologic studies suggest that intermellar and interfibrillar biomechanical slippage occurs when the cornea becomes ectatic after lasik or prk in the postoperative stressbearing regions. A registry for reporting cases of ectasia after lasik had its debut recently.
The case below is a case of a patient that i share with my good friend and colleague jeffery ing, md of stockton, ca. Stoneciphers patient returned in 2007 for additional treatment but showed signs of keratoectasia source. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and postlasik ectasia. Corneal ectasia is a rare but devastating complication of lasik surgery. 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. Corneal ectasia following lasik surgery causes changes in the shape of the cornea and can lead to decreased vision. Postoperatively, most of the ectatic eyes evaluated by the investigators achieved a final bcva of 2040 with rigid gas permeable contact lenses 57 eyes, spectacles seven eyes. The sameday, simultaneous topographyguided prk and cxl procedure was easy. Postoperative corneal ectasia has been estimated to occur in 0. 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.
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