Reported rates of postlasik ectasia in eyes without identified risk factors have declined in recent years. Early detection of ectasia is critical to maximize ultimate visual acuity when this complication does occur. Tratamiento ectasia corneal post lasik a compensacion optica. Combining cxl with lenticule addition is therefore a potential method. While accomplishing new studies to combine tomographic. 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.
Known risk factors for post lasik corneal ectasia in miami. Treating post lasik ectasia with corneal crosslinking by enette ngoei eyeworld contributing editor dr. In most cases, the stromal thinning that happens during lasik or other laser operations cause corneal ectasia. Iatrogenic ectasias occur primarily through postcorneal refractive surgery. The rate of purely iatrogenic post lasik ectasia at our center was 0. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. At global contact lens specialists, we specialize in post lasik and post rk failures and side effects. Ectasia is a particularly insidious complication of lasik. 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 risk factors. Eyeworld ectasia ectasia, topography readings hot topics among military refractive surgeons all years 2020 2019 2018 2017 2016 2015 2014 20 2012 2011 2010 2009 2008 2007 all months january february march april may june july august september october november december. Ectasia after refractive surgery is a progressive increase in myopia, with or. Traditional options for treatment, most notably penetrating keratoplasty, can salvage vision but have significant downsides. Apr 15, 2015 iatrogenic ectasias occur primarily through post corneal refractive surgery. The medical literature contains reports of late onset ectasia occuring several years after lasik. Ectasia after lasik, corneal postlasik ectasia a state.
Postlaserassisted in situ keratomileusis lasik ectasia is a potential. These have included partial transplant techniques, and more recently using. If corneal ectasia develops, there are many options available for treatment before an eye becomes a candidate for penetrating keratoplasty pkp. Decreasing vision after laserassisted insitu keratomileusis lasik history of present illness. Trattler pointed out, there are significant differences in opinion regarding the relevance of risk factors. Although exact prevalence of postlasik ectasia is not known, reported prevalence rates change between 0. Risk factors for ectasia after lasik include irregular preop corneal astigmatism and thin postop corneal thickness under the flap. To describe the case of a patient developing corneal ectasia following lasik for the correction of myopic astigmatism. Furthermore, it is reported many years after surgery. The combined intervention improved udva from 2070 to 2040 and. My visual acuity in this eye also became very poor. Corneal ectasia after myopic laser in situ keratomileusis. 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.
In spite of these improvements, no statistically significant improvements were. Dec 18, 2012 corneal ectasia following lasik surgery causes changes in the shape of the cornea and can lead to decreased vision. Post laser in situ keratomileusis lasik corneal ectasia is one of the most feared complications of refractive surgery. We did not combine our treatment measures with photorefractive keratectomy prk, as described by kanellopoulos in the athens protocol. Ectasia after lasik american academy of ophthalmology. Corneal ectasia following lasik surgery causes changes in the shape of the cornea and can lead to decreased vision. To identify factors that can lead to corneal ectasia after laser in situ keratomileusis lasik. Azman utilizes nonsurgical restoration techniques to restore quality vision to those who have lost it due to lasik failures and lasik complications, rk surgery, corneal transplant surgery, ocular trauma, dry eye and corneal disease. Specifically, we have introduced the concept of accelerated, highfluence collagen crosslinking in postlasik ectasia 32, as well as the utilization of prophylactic cxl in routine lasik 33.
Corneal ectasia induced by laser in situ keratomileusis ioannis g. High order aberration outcomes of corneal collagen. Pdf thirtymonth results after the treatment of postlasik ectasia. Sep 08, 2007 ectasiawhether postlasik or keratoconushas always been an unwelcome occurrence. Azman utilizes nonsurgical restoration techniques to restore quality vision to those who have lost it due to lasik failures and lasik complications, rk surgery, corneal transplant. Management of corneal ectasia after lasik with combined. Crosslinking is the goldstandard treatment for progressive corneal ectasia. Fortunately, new options have proliferated in recent years. In this episode of a state of sight, isaac porter, md explains postlasik. Risk profiles of ectasia after keratorefractive surgery. 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. Corneal ectasia resembles a similar bulging cornea condition known as keratoconus.
Topographical features and surgical parameters of those patients were evaluated. Pvr prose treatment for corneal ectasia pvr prose treatment prosthetic replacement of the ocular surface ecosystem uses. Pdf on jun 1, 2018, thiago jmm mazzeo and others published postlasik ectasia associated with. A 33year old gentleman developed ectasia 12 years following an uneventful lasik. Lateonset postlasik ectasia with no apparent risk factor.
Corneal ectasia pvr prose treatment post lasik problems. Over time, the weakened cornea loses its shape and bulges forward, resulting in distorted vision that cannot be corrected with eyeglasses. 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. However, corneal ectasia can appear, mainly after the treatment of high myopic refractive errors, high manifested astigmatisms, high corneal curvature, thin corneal pachymetry and irregular astigmatisms. Dec 20, 2006 corneal ectasia after photorefractive keratectomy prk has only been occasionally reported, and its incidence has not been assessed. To evaluate the risk factors for postlaser in situ keratomileusis lasik ectasia. Combining cxl and prk has been proposed to stabilize the cornea while.
Postlaser in situ keratomileusis lasik corneal ectasia is one of the most feared complications of refractive surgery. The clinical onset of keratoectasia can occur months or even years after the surgery. 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 can occur shortly after lasik, small incision lenticule. Successful cases of lasik are reported from short term followup periods but the incidence of late onset corneal ectasia following lasik is not known. Posts about corneal ectasia written by azmaneyecare. Jan 15, 2006 an understanding of earlystage and forme fruste keratoconus is critical for preventing post lasik ectasia, preserving the patients visual quality and protecting your practice from lawsuits.
The rate of eyes with unrecognized preoperative ffkc that developed post lasik ectasia was 5. Internal pressure from within the eye can cause expansion or distension of the cornea. 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. High order aberration outcomes of corneal collagen crosslinking in eyes with keratoconus and post lasik ectasia. Irwin azman has over 25 years of experience in the diagnosis and management of the post lasik patient with lasik failures and lasik complications. The sameday, simultaneous topographyguided prk and cxl procedure was easy. Easy calculation evaluates postlasik ectasia risk american. Eyeworld treating postlasik ectasia with corneal crosslinking. Pdf risk factors for post lasik ectasia yuri mercado. Corneal ectasia after photorefractive keratectomy springerlink. A registry for reporting cases of ectasia after lasik had its debut recently. Postlasik ectasia was considered as increasing myopia with or without developing astigmatism, reduction of uncorrected visual acuity. Today, nearly 10 years after the first case was reported, iatrogenic, postlasik ectasia is one of the most controversial issues in refractive surgery.
Eyeworld ectasia, topography readings hot topics among. The exact risk for post lasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. Postoperative corneal ectasia has been estimated to occur in 0. To identify factors that can lead to corneal ectasia after laser in situ kerato mileusis lasik. May 11, 2018 a 33year old gentleman developed ectasia 12 years following an uneventful lasik. Features and prognosis were evaluated in all patients with. Eye freedom after lasik, the cornea has been made thinner. Thankfully, with the development of cxl, patients who are diagnosed with keratoconus or postlasik ectasia now have a safe and effective therapy that can stop the condition from worsening in 97% to 99% of cases with a single treatment. In this episode of a state of sight, isaac porter, md explains post lasik. Studies suggest it may occur in roughly one of every 2,000 lasik procedures.
An understanding of earlystage and forme fruste keratoconus is critical for preventing postlasik ectasia, preserving the patients visual quality and protecting your practice from lawsuits. The condition is due to the weakening of the inner layers of the cornea, which occurs during surgery. Postlasik ectasia was described first by seiler et al. Postlasik corneal ectasia is a noninflammatory process that results in deformation of the cornea along with thinning and biome chanical weakening110. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and postlasik ectasia. 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. Results in irregular astigmatism with accompanying blurred andor distorted vision. Bilateral ectasia after femtosecond laserassisted small. Post lasik ectasia was considered as increasing myopia with or without developing astigmatism, reduction of uncorrected visual acuity.
Corneal ectasia post lasik complication new treatment info. 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. Pdf postlasik ectasia associated with pigmentary glaucoma. Early identification of patients with keratoconus and post.
Late onset corneal ectasia after lasik surgery sciencedirect. Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for possible risk factors such as keratoconus. The combined intervention improved udva from 2070 to 2040 and cdva from 2040 to 2020 with 2 years followup. Corneal ectasia induced by laser in situ keratomileusis. Newer treatment modalities have been developed to tackle this rare, yet devastating complication of refractive surgery. The exact risk for postlasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. Keratoconus and corneal ectasia after lasik request pdf. Postlasik corneal ectasia in patients with significant. 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. The rate of purely iatrogenic postlasik ectasia at our center was 0. Postlasik ectasia post surgical complication of lasik eye refractive surgery. The case below is a case of a patient that i share with my good friend and colleague jeffery ing, md of stockton, ca. 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.
Histopathologic studies suggest that intermellar and interfibrillar biomechanical slippage occurs when the cornea becomes ectatic after lasik or prk in the postoperative stressbearing regions. 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. Letter from a patient that developed keratoconus after. I eventually found out that the laser surgery had caused postlasik ectasia, which is a form of keratoconus where the cornea thins. Ectasiawhether postlasik or keratoconushas always been an unwelcome occurrence.
Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for. However, it is often difficult to convince postlasik. Pdf background to report a first case of lenticule addition and corneal cross linking for postlasik ectasia with associated corneal thinning. Undertheflap crosslinking and lasik in early ectasia with. Post lasik ectasia, ectasia, lasik, visante, visante omni, pentacam. Incidence, risk factors, and treatment for ectasia, keratoconus after lasik. Stoneciphers patient returned in 2007 for additional treatment but showed signs of keratoectasia source.
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. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and post lasik ectasia. Evaluation of a risk factor scoring system for corneal ectasia after lasik in eyes with normal topography. Thirtymonth results after the treatment of postlasik ectasia with.
Known risk factors for postlasik corneal ectasia in miami. This 56yearold woman presented status post bilateral lasik for myopia at an outside institution. The patient had had lasik performed elsewhere and subsequently developed ectasia. The appearance and progression of postlasik ectasia are similar to a degenerative disease of the cornea called keratoconus. Management of corneal ectasia after lasik with combined, same. Postlasik ectasia is the most feared complication following lasik, occurring in majority of cases within 1 year of surgery. A 39yearold man underwent bilateral uneventful lasik for myopic astigmatism of 10. In this case report, we describe and analyze a postlasik ectasia case in one eye which was diagnosed after 11 years without any risk. Managing corneal ectasia prior to keratoplasty oculus pentacam. Full text ectasia risk factors in refractive surgery opth. Corneal ectasia or corneal ectatic disorders is a group of disorders that include uncommon, noninflammatory eye disorders. Thankfully, with the development of cxl, patients who are diagnosed with keratoconus or post lasik ectasia now have a safe and effective therapy that can stop the condition from worsening in 97% to 99% of cases with a single treatment. 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. Post lasik ectasia was described first by seiler et al.
Post surgical ectasia is a condition resembling keratoconus but comes from a different origin. Corneal ectasia after photorefractive keratectomy prk has only been occasionally reported, and its incidence has not been assessed. Preoperative corneal pachymetry was 542 micrometers od and 543 micrometers os. They are helpful in restoring vision, supporting in corneal healing and improving overall quality of life of complex corneal diseases patients. Treating postlasik ectasia with corneal crosslinking by enette ngoei eyeworld contributing editor dr. The appearance and progression of post lasik ectasia are similar to a degenerative disease of the cornea called keratoconus. Lasik, ectasia, visual acuity, forme fruste keratoconus, topography. Give the changes in the magnification and minification changes induced there is moderate miscalculation on part of the scheimpflug system. A special gas permeable contact or scleral lens will be needed to restore lost vision. Postsurgical ectasia is a condition resembling keratoconus but comes from a different origin. High order aberration outcomes of corneal collagen crosslinking in eyes with keratoconus and postlasik ectasia. 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. Another study reported that thin cct is not an isolatedriskfactorforpostlasikectasiaineyeswithnormal topographical ndings.
Letter from a patient that developed keratoconus after lasik. Postlasik ectasia treated with intrastromal corneal ring segments. Ectasia after lasik, corneal postlasik ectasia a state of. Postlasik ectasia associated with pigmentary glaucoma. Treating postlasik ectasia with corneal crosslinking. Corneal ectasia remains an enigmatic, potentially devastating complication of laser in situ keratomileusis 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. Corneal ectasia has been reported with an incidence of 1 in 2,500 after lasik 1 and 1 in 3,300 after photorefractive keratectomy prk. Clinical study risk factors in postlasik corneal ectasia. Amin ashrafzadeh, md post lasik ectasia evaluated with. 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. Risk factors and prognosis for corneal ectasia after lasik. Rate of ectasia and incidence of irregular topography in. 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.
1314 1287 217 696 1425 757 1181 1061 1417 954 395 1295 1237 656 1223 383 1262 497 830 874 1150 673 942 939 1371 10 638 1103 60 144 745 1299 74 562