A special gas permeable contact or scleral lens will be needed to restore lost vision. Mar 05, 2014 the first phase will establish a database for submission of information on patients who developed ectasia after lasik. The pathogenesis of postlasik ectasia ple remains underexplored. Corneal ectasia post lasik complication new treatment info. Background the purpose of this study was to evaluate the longterm postoperative incidence of and key factors in the genesis of corneal ectasia after myopic laserassisted in situ keratomileusis lasik in a large number of cases. A registry for reporting cases of ectasia after lasik had its debut recently. Corneal collagen crosslinking for ectasia after laser in. Corneal ectasia induced by laser in situ keratomileusis ioannis g. Proof that lasik surgeons are aware of the legal requirement to report post lasik ectasia to the fda, but dont. Corneal ectasia induced by laser in situ keratomileusis. To evaluate the risk factors for post laser in situ keratomileusis lasik ectasia. 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.
Eightytwo eyes 54 keratoconus, 28 postlasik ectasia of 65 patients had cxl and were followed for 1 year. Relevant factors in refractive surgery screening include. Ectasia after lasik, postlasik keratectasia youtube. Such a patient clearly has a case of postlasik ectasia. These cases will be evaluated against a control group of lasik patients who did not develop ectasia, in an effort to validate known risk factors and discover new ones. Easy calculation evaluates postlasik ectasia risk american.
A thirtynine year old man was referred to our institute due to progressive decreased visual acuity five years after bilateral laser in situ keratomileusis lasik. In vivo confocal microscopy and tear cytokine analysis in. Results in irregular astigmatism with accompanying blurred andor distorted vision. After lasik, the cornea is structurally weakened, not only by the laser central stromal ablation, but also by the creation of the flap itself. Post lasik ectasia was considered as increasing myopia with or without developing astigmatism, reduction of uncorrected visual acuity. Pdf on sep 15, 2012, ramez barbara and others published late onset post lasik ectasia find, read and cite all the research you need on. Post lasik ectasia of the cornea is one of the most severe complications of lasik laser in situ keratomileusis. Unilateral ectasia after lasik in a patient with abnormal docteur.
Regardless, he said that corneal crosslinking is the proper procedure to perform on somebody who has ectasia. This condition, commonly referred to as post lasik ectasia, behaves in a manner similar to that of keratoconus. Mar 20, 2010 the rate of ectasia after lasik is uknown due to failure of lasik surgeons to report complications and lack of longterm followup. Treatment options are available with keratoplasty as the last resort. We evaluated clinical safety and longterm efficacy of topographyguided excimer laser enhancement combined with higher variable fluence and pattern refractive cxl as demonstrated in this video. Fiftysix eyes 35 keratoconus, 21 ectasia received hypotonic riboflavin before uva light administration, and 26eyes 19 keratoconus, 7ectasia received standard dextran riboflavin solution only. The corneal shape has become more regular, but the patient needs to remain on the drops to keep the effect. The pathogenesis of post lasik ectasia ple remains underexplored. The rate of ectasia after lasik is uknown due to failure of lasik surgeons to report complications and lack of longterm followup. Ectasia after lasik american academy of ophthalmology.
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. Postlasik ectasia is a condition similar to keratoconus where the cornea starts to bulge. Postkeratorefractive surgical ectasia has been postulated to occur as a result of insufficient. Three years after the last lasik enhancement treatment. She reported that after she underwent lasik, the vision in her left eye was great and. The exact risk for post lasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. We studied a group of patients referred to a universitybased refractive surgery center who developed ectasia after lasik to identify factors that may have. If corneal ectasia develops, there are many options available for treatment before an eye becomes a candidate for penetrating keratoplasty pkp.
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. Ectasia after lasik postlasik keratoconus corneal ectasia. Deep anterior lamellar keratoplasty in postlaser in situ. Thirtymonth results after the treatment of postlasik. 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. Corneal ectasia occurs when the inner layers of your cornea become weak, causing the cornea to change shape, protrude forward and distort your vision. 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. Known risk factors for post lasik corneal ectasia in miami. Post surgical ectasia is a condition resembling keratoconus but comes from a different origin. To report a first case of lenticule addition and corneal crosslinking for postlasik ectasia with associated corneal thinning. Postoperative factors may play a role in the pathogenesis of postlasik corneal ectasia. Post lasik ectasia surgical management of post lasik ectasia effective for majority of patients by dermot mcgrath in paris for refractive and cataract surgery reaching a new level in corneal tomography patented dual scheimpflug system provides highly accurate pachymetry and raytracing, even when the measurement is decentred. Listen to presentation given during a private meeting of lasik surgeons, in which the speaker admits that ectasia cases are not being reported as required by federal law, and that the rate of post lasik ectasia is likely a lot.
Eye freedom after lasik, the cornea has been made thinner. Postsurgical ectasia is a condition resembling keratoconus but comes from a different origin. Surgical techniques are evolving for the treatment of both keratoconus and postlasik ectasia. Postlasik ectasia may be a new name for an old disease. To evaluate the risk factors for postlaser in situ keratomileusis lasik ectasia. Internal pressure from within the eye can cause expansion or distension of the cornea. The cases presented, herewith, had late onset postlasik ectasia despite normal preop corneal topography, calculated residual corneal stromal bed thickness of more than 250. A computer database was queried for eyes that had lasik for myopic refractive errors with the following. Although postlasik corneal ectasia may be managed conservatively with rigid gaspermeable lenses, this nonsurgical treatment option may fail or may represent an unacceptable alternative for patients who underwent refractive. Postlasik ectasia wikimili, the best wikipedia reader. Its what many practitioners worry abouta postlasik patient comes in with signs of a thinning, bulging cornea. The lasik community has taken the issue very, very seriously.
The appearance and progression of postlasik ectasia are similar to a degenerative disease of the cornea called keratoconus. High percentage of tissue altered pta is the most robust risk factor for ectasia after lasik in patients with normal preoperative corneal. Bilateral loss in the quality of vision associated with anterior corneal. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and postlasik ectasia. Ectatic corneal disorders including keratoconus and ectasia after lasik are the second most common indications for keratoplasty, accounting for about 15% of corneal transplants performed in the. Pdf incidence and clinical characteristics of post lasik ectasia. We report the case of a 29yearold man who underwent lasik in both eyes and in whom corneal ectasia developed in the left eye 3 years after surgery. Pdf management of post laser in situ keratomileusis. Corneal collagen crosslinking for ectasia after laser in situ.
Patients with forme fruste keratoconus have a high risk for developing iatrogenic ectasia after lasik 11. Aim corneal keratectasia is one of the complications associated with laser in situ keratomileusis lasik that results in vision impairment. This condition, commonly referred to as postlasik ectasia, behaves in a manner similar to that of keratoconus. Pdf risk factors for post lasik ectasia yuri mercado. Postlasik corneal ectasia is a rare but a serious complication which leads to decreased visual acuity. The 2 main risk factors for postlasik keratectasia are a residual corneal bed of 250. 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. May 11, 2018 we evaluated clinical safety and longterm efficacy of topographyguided excimer laser enhancement combined with higher variable fluence and pattern refractive cxl as demonstrated in this video. Threestep treatment of keratoconus and postlasik ectasia. There are likely several thousand patients suffering from post. Decreasing vision after laserassisted insitu keratomileusis lasik history of present illness.
Thirtyone eyes of 24 patients with moderate to severe keratoconus and postlasik ectasia stages ii and iii of amslerkrumeich classification were included. Ectatic corneas are both a contraindication and an occasional consequence of lasik. Until postlasik ectasia is better understood, there will be unhappy patients. The findings of our study showed that most of the patients who developed post lasik ectasia have a risk factor for post lasik ectasia. Bradley randleman, md, buddy russell, fclsa, michael a. Pdf management of post laser in situ keratomileusis ectasia. Postlasik ectasia surgical management of postlasik ectasia effective for majority of patients by dermot mcgrath in paris for refractive and cataract surgery reaching a new level in corneal tomography patented dual scheimpflug system provides highly accurate pachymetry and raytracing, even when the measurement is decentred. To examine a database of laser in situ keratomileusis lasik procedures for preoperative and operative factors assumed to increase the risk for developing post lasik ectasia. Upon completion of this issue, you should be able to. Studies suggest it may occur in roughly one of every 2,000 lasik procedures. Corneal ectasia can occur shortly after lasik, small incision lenticule extraction. Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for. We report the tear cytokine profile and in vivo confocal microscopy ivcm findings in eyes with ple.
How to assess the risk of post lasik ectasia before recommending laser vision correction, optometrists can spot patients likely to suffer complications. Late onset corneal ectasia after lasik surgery sciencedirect. Iatrogenic corneal ectasia after laser in situ keratomileusis lasik is a rare but devastating complication of refractive surgery. Dec 15, 2018 published december 15, 2018 corneal compromise. Treating postlasik ectasia with corneal crosslinking by enette ngoei eyeworld contributing editor dr. With all lasik surgeries, the prevention of postoperative ectasia through careful preoperative screening is of paramount importance. A postlasik ectasia patient who was caught early bottom topography. Postlasik corneal ectasia is a rare but serious late postoperative complication.
The findings of our study showed that most of the patients who developed postlasik ectasia have a risk factor for postlasik ectasia. This appears to be an unfortunate case of postlasik ectasia in a patient who is a confirmed highrisk eye rubber. Management of postlasik corneal ectasia with intacs inserts. 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. 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. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and post lasik ectasia. Upon comparing the clinical characteristics of patients with ectasia 86 eyes of 59 patients and those who underwent uncomplicated lasik 103 eyes of 63 patients, the investigators identified nine postoperative clinical variables that were significantly associated with corneal ectasia after lasik. It is associated with progressive corneal steepening, an increase in myopia and astigmatism, and a decrease in uncorrected and corrected visual acuity. Nov 01, 2005 ectatic corneal disorders including keratoconus and ectasia after lasik are the second most common indications for keratoplasty, accounting for about 15% of corneal transplants performed in the. Eyeworld treating postlasik ectasia with corneal crosslinking. Histopathological analysis of postlaserassisted in situ. Corneal ectasia is a serious complication of laser in situ keratomileusis lasik.
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. Patients were stratified into two groups based on date of surgery, ie, group 1. To report the incidence of postoperative ectasia after laser in situ keratomileusis lasik. Corneal ectasia vision distortion is there a clear solution. The lasik procedure permanently weakens and thins out the cornea, resulting in progressive changes in the cornea such as steepening or bulging, called ectasia. Known risk factors for postlasik 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. Objective to prospectively study the effects of the use of intacs microthin prescription inserts addition technology inc, fremont, calif for the postoperative management of corneal ectasia resulting from laser in situ keratomileusis lasik. Risk profiles of ectasia after keratorefractive surgery. The causes of ectasia are manifold, but a significant rise in postlasik ectasia has been seen. Post lasik corneal ectasia is a rare but a serious complication which leads to decreased visual acuity. The first phase will establish a database for submission of information on patients who developed ectasia after lasik. The exact risk for postlasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. And there will be doctors who are wary of the medicolegal consequences. To identify factors that can lead to corneal ectasia after laser in situ kerato mileusis lasik. Ectasia prevalence can be decreased by determining risk factors which lead to postlasik corneal ectasia. The most frequent topic being discussed by lasik surgeons in journals and at conferences is the development of methods of prescreening patients to reduce the rate of postlasik ectasia. Risk factors and prognosis for corneal ectasia after lasik j. Keratoconus and corneal ectasia after lasik request pdf. Dec 15, 2004 a post lasik ectasia patient who was caught early bottom topography.
Analysis of ectasia after laser in situ keratomileusis. Post lasik ectasia treatment for post lasik side effects. The appearance and progression of post lasik ectasia are similar to a degenerative disease of the cornea called keratoconus. Thirtymonth results after the treatment of postlasik ectasia with. Risk factors and prognosis for corneal ectasia after lasik. Corneal ectasia preferred practice pattern ophthalmology. Ectasia prevalence can be decreased by determining risk factors which lead to post lasik corneal ectasia. Stoneciphers patient returned in 2007 for additional treatment but showed signs of keratoectasia source. This 56yearold woman presented status post bilateral lasik for myopia at an outside institution. Methods this retrospective study included agematched 7 14 eyes post lasik controls plcs and 6 12 eyes ple subjects. Management of corneal ectasia after lasik with phototherapeutic. He was treated sequentially with intraocular pressurelowering medication, intrastro. Topographical features and surgical parameters of those patients were evaluated.