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. 2023 Mar;35(1):73-78.
doi: 10.5455/msm.2023.35.73-78.

Management of Post-LASIK Ectasia

Maja Bohac  1 , Alma Biscevic  1   2 , Melisa Ahmedbegovic-Pjano  2 , Mateja Jagic  1 , Doria Gabric  1 , Selma Lukacevic  1 , Ivana Mravicic  1
Affiliations

Management of Post-LASIK Ectasia

Maja Bohac et al. Mater Sociomed. 2023 Mar.

Abstract

Background: Corneal ectasia is a sight-threatening complication of corneal refractive surgery characterized by progressive steepening and thinning of the cornea and subsequent loss of best-corrected visual acuity.

Objective: To report the clinical outcomes following treatment of post-laser in situ keratomileusis (LASIK) induced ectasia.

Methods: This is a retrospective case series of 7 patients (10 eyes) which developed post-LASIK ectasia. In these cases of postoperative ectasia, the presented clinical signs were either forme fruste keratoconus, thin cornea, posterior elevation map value > +15.0µm, or residual stromal bed < 300µm. All cases were treated with either collagen crosslinking (CXL) alone or combined with PRK or CXL and phakic intraocular implant using the Dresden protocol and a slight modification thereof. In all cases, the flap was created using the Moria M2 mechanical microkeratome (average flap thickness 118.15±12.88µm), and refractive error was corrected using the Wavelight Allegretto excimer laser.

Results: Average preoperative corrected visual acuity (CDVA) was 0.75 (±0.26) Snellen. Postoperative CDVA significantly increased to 0.86 (±0.13) Snellen (p=0.04, paired t-test). One eye lost three lines of its baseline CDVA (before ectasia), while all other eyes regained lines of CDVA. All cases remained stable during the follow-up.

Conclusion: Several surgical procedures are used for the management of corneal ectasia. However, the best surgical approach should be determined based on the state of progression of the disease. Although ectasia remains a potentially devastating complication after refractive surgery, most patients can regain functional visual acuity with appropriate management, and corneal transplantation is infrequently indicated.

Keywords: LASIK; corneal tomography; crosslinking; ectasia; keratoconus.

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Conflict of interest statement

Bone declared.

Figures

Figure 1.
Figure 1.. Difference map of the right eye from Case 1 six years after CXL
Figure 2.
Figure 2.. Difference map of the left eye from Case 5 one year after CXL
Figure 3.
Figure 3.. Difference map of the right eye from Case 6 two weeks after corneal wavefront-guided PRK and CXL
Figure 4.
Figure 4.. Difference map of the left eye from Case 6 two weeks after corneal wavefront-guided PRK and CXL
Figure 5.
Figure 5.. Difference map of the left eye from Case 7 two months after corneal wavefront-guided PRK and CXL
See this image and copyright information in PMC

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