Early detection of ectasia is critical to maximize ultimate visual acuity when this complication does occur. Randleman and perezstraziota discuss the causes of, risk factors for, and management of ectasia. Ectasia after lasik, corneal postlasik ectasia a state. The clinical onset of keratoectasia can occur months or even years after the surgery. 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. Corneal ectasia induced by laser in situ keratomileusis ioannis g. It is more likely to occur following lasik, radial keratotomy rk, or astigmatic keratotomy ak surgery. 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.
Corneal ectasia following lasik surgery causes changes in the shape of the cornea and can lead to decreased vision. Multicenter clinical trial of corneal collagen crosslinking for treatment of corneal ectasia after refractive surgery peter s. Pvr prose treatment for corneal ectasia pvr prose treatment prosthetic replacement of the ocular surface ecosystem uses. Additionally, the slit lamp picture of pmd shows marked corneal stromal thinning close to the inferior limbus. Apr 18, 2012 reduction of corneal biomechanical strength seems to be an essential element in the chain of events leading to post lasik corneal ectasia. Postlvc ectasia is a biomechanical failure of the wall of the cornea, resulting in thinning and protrusion, but without acute inflammation. 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. A special gas permeable contact or scleral lens will be needed to restore lost vision. Laser procedures carry different biomechanical effects, due to different flap cut parameters. High order aberration outcomes of corneal collagen. Histopathologic studies suggest that intermellar and interfibrillar biomechanical slippage occurs when the cornea becomes ectatic after lasik or prk in the postoperative stressbearing regions. Eyeworld corneal crosslinking treating postlasik ectasia with corneal crosslinking 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.
These lenses make for the perfect primary optical surface for the eye and mark any and all irregularities of. Ectasia after lasik, corneal postlasik ectasia a state of. 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. Known risk factors for postlasik corneal ectasia in miami. In keratoconus the apex of the cone and the corneal thinning is usually more centrally located. Post lasik ectasia treated with intrastromal corneal ring segments and corneal crosslinking kay lam, md, dan b. To identify factors that can lead to corneal ectasia after laser in situ keratomileusis lasik. Postoperative corneal ectasia remains one of the most insidious and feared complications after photorefractive keratectomy prk, laser in situ keratomileusis lasik, and the most recent.
Add to that the fact that around 90% of those with post lasik ectasia cases also exhibited signs of genetic keratoconus. Iatrogenic ectasias occur primarily through postcorneal refractive surgery. 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. Ectasia after refractive surgery is a progressive increase in myopia, with or without. Scleral lenses and their use in postlasik corneal ectasia. Corneal ectasia preferred practice pattern ophthalmology. Corneal ectasia is a rare but devastating complication of lasik surgery. Late onset corneal ectasia after lasik surgery sciencedirect. Corneal ectasia post lasik complication new treatment info. Treatments for postlasik ectasia are the same as for keratoconus, said dr. Nineteen patients with late onset corneal ectasia following lasik procedure were examined at the eye center, riyadh, saudi arabia.
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. This 56yearold woman presented status post bilateral lasik for myopia at an outside institution. Posts about corneal ectasia written by azmaneyecare. Corneal ectasia vision distortion is there a clear solution. Lasik leads to significant and permanent biomechanical weakening of the cornea, which may lead to a sightrobbing complication known as postlasik corneal ectasia. Doyle stulting, md, phd,3 david muller, phd,4 daniel s. Corneal ectasia induced by laser in situ keratomileusis. Combining cxl and prk has been proposed to stabilize the cornea while. To report late onset corneal ectasia following myopic lasik. Managing corneal ectasia prior to keratoplasty oculus pentacam. Corneal ectasia pvr prose treatment post lasik problems. Risk factors and prognosis for corneal ectasia after lasik. Results in irregular astigmatism with accompanying blurred andor distorted vision. Early identification of patients with keratoconus and post.
Over time, the weakened cornea loses its shape and bulges forward, resulting in distorted vision that cannot be corrected with eyeglasses. Late onset corneal ectasia after lasik surgery johns. 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. Risk factors for ectasia after lasik include irregular preop corneal astigmatism and thin postop corneal thickness under the flap. Postlaser in situ keratomileusis lasik corneal ectasia is one of the most serious side effects of refractive surgery. Keratoconus and corneal ectasia after lasik request pdf. Irwin azman has over 25 years of experience in the diagnosis and management of the post lasik patient with lasik failures and lasik complications. Ectasia is a particularly insidious complication of lasik. 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. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and post lasik ectasia. Pdf to evaluate the 1year results of corneal collagen crosslinking cxl in eyes with postoperative excimer laser refractive surgery corneal. Preferred practice pattern guidelines free download available at.
Even if an eye warrants pk, the prognosis is excellent, according to the 2005 consensus group, which reported graft survival rates of 97 percent and 92 percent at five and 10 years, respectively. High order aberration outcomes of corneal collagen crosslinking in eyes with keratoconus and postlasik ectasia. Easy calculation evaluates postlasik ectasia risk american. Corneal ectasia results in the visual deterioration. Most cases of postlasik ectasia can be successfully treated. Newer treatment modalities have been developed to tackle this rare, yet devastating complication of refractive surgery. Combining cxl and prk has been proposed to stabilize the cornea while providing. The condition is due to the weakening of the inner layers of the cornea, which occurs during surgery. Postlasik ectasia treated with intrastromal corneal ring segments and corneal crosslinking. Jan 15, 2006 abnormal topography maps, corneal thickness and other measurements can serve as red flags for potential post op ectasia. In this episode of a state of sight, isaac porter, md explains post lasik. Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for possible risk factors such as keratoconus. Postoperative corneal ectasia has been estimated to occur in 0.
In this episode of a state of sight, isaac porter, md explains postlasik. The role of corneal biomechanics for the evaluation of ectasia. Decreasing vision after laserassisted insitu keratomileusis lasik history of present illness. Postoperative corneal ectasia remains one of the most insidious and feared complications after photorefractive keratectomy prk, laser in situ keratomileusis lasik, and the most recent procedures, such as small incision lenticule extraction smile. We did not combine our treatment measures with photorefractive. Eye freedom after lasik, the cornea has been made thinner. Request pdf on nov 1, 2005, perry s binder and others published keratoconus and corneal ectasia after lasik find, read and cite all the research you need on researchgate. Corneal ectasia after photorefractive keratectomy springerlink.
Postlasik ectasia was considered as increasing myopia with or without developing astigmatism, reduction of uncorrected visual acuity, keratometric steepening with or without central and. Post laserassisted in situ keratomileusis ectasia semantic scholar. Pdf managing corneal ectasia prior to keratoplasty researchgate. 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. Arresting the freefall of corneal ectasia what you need to know about the current results of using corneal crosslinking as a treatment for postlasik ectasia. Eyeworld treating postlasik ectasia with corneal crosslinking. Postrefractive surgery ectasia is a loss of corneal integrity leading to corneal warpage that often resembles keratoconus. Characteristics of corneal ectasia after lasik for myopia. Pdf corneal collagen crosslinking for ectasia after excimer. Preventing ectasia with crosslinking after prk or lasik cataract. Ectasia after lasik american academy of ophthalmology. Pdf the advent of refractive surgery allowed for great advances in the understanding of pathophysiology. Treating post lasik ectasia with corneal crosslinking by enette ngoei eyeworld contributing editor dr. Within the stroma, intralamellar bonds can fracture and slip under the stress of outside forces, such as intraocular pressure iop, eye rubbing, blinking and extraocular muscle forces.
Corneal ectasia or corneal ectatic disorders is a group of disorders that include uncommon, noninflammatory eye disorders. Corneal ectasia can occur shortly after lasik and photorefractive. Post lasik corneal ectasia is a rare but a serious complication which leads to decreased visual acuity. 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. Therefore, cxl may provide an a viable and repeatable alternative for post lasik corneal ectasia by stabilizing the biomechanical properties of the cornea and avoiding the need for a penetrating. Corneal ectasia, laser in situ keratomileusis, intracorneal ring. To identify factors that can lead to corneal ectasia after laser in situ kerato mileusis lasik. Postlasik ectasiaor corneal ectasiais a rare but serious complication of lasik laser eye surgery.
Postoperatively, the corneal power and elevation were stable with a remarkable improvement in corneal thickness, and the lenticule had merged. Sep 15, 2005 additionally, the slit lamp picture of pmd shows marked corneal stromal thinning close to the inferior limbus. 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. Apr 15, 2015 iatrogenic ectasias occur primarily through post corneal refractive surgery. Thirtymonth results after the treatment of postlasik ectasia with. Treating postlasik ectasia with corneal crosslinking. Post lasik ectasia was considered as increasing myopia with or without developing astigmatism, reduction of uncorrected visual acuity, keratometric steepening with or without central and. After lasik, the cornea appears to be mechanically weakened by the tissue ablation and the lamellar cut,12 but it is not known to what degree this contributes to the cause and mechanism of post lasik ectasia. In the past, the primary treatment options were rigid gas permeable rgp or gp contact lenses and implantation of intrastromal corneal ring segments, such as intacs. Corneal ectasia can occur shortly after lasik, small incision lenticule extraction.
That said, theres good news on this front as thanks to scleral lenses, postlasik corneal ectasia can be corrected quite easily without the need for any invasive surgery. International journal of keratoconus and ectatic corneal diseases, septemberdecember 2014. The treatments are similar to those used to treat keratoconus. Combining the impact from the procedure with an advanced corneal. A medline search for lasik and ectasia yielded 21 relevant articles published before may 2003 n 86 eyes, 59 patients. A 42yearold female presents for refractive surgery in september 1996. 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. Abnormal topography maps, corneal thickness and other measurements can serve as red flags for potential postop ectasia. Internal pressure from within the eye can cause expansion or distension of the cornea.
The results of these studies, evaluating the efficacy, stability, and safety of corneal cxl for ectasia, are limited by short followup. Mar 05, 2014 post refractive surgery ectasia is a loss of corneal integrity leading to corneal warpage that often resembles keratoconus. In the case of postlasik ectasia, the old corneal flap was lifted again. Postlasik corneal ectasia is a type of corneal distortion, just like keratoconus scleral lenses and their use in postlasik corneal ectasia it is common for patients who undergo the lasik surgery to have a quick recovery without any lasting complications. Successful cases of lasik are reported from short term followup periods but the incidence of late onset corneal ectasia following lasik is not known. Keratoconus and post lasik ectasia keratectasia are histologically two different processes. Ectasia after lasik postlasik keratoconus corneal ectasia. Current theories suggest that the two main causes of postlasik ectasia are preexisting corneal pathology keratoconus or forme fruste keratoconus, mechanical instability produced by the weakening of the residual corneal stromal bed induced by the flap creation, the effect of laser ablation, and probably eye rubbing.
While accomplishing new studies to combine tomographic. To evaluate the risk factors for postlaser in situ keratomileusis lasik ectasia. Most cases of post lasik ectasia can be successfully treated. The disease is characterized by a progressive thinning and steepening of the central and inferior portions of the. 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. They are helpful in restoring vision, supporting in corneal healing and improving overall quality of life of complex corneal diseases. In the past, the primary treatment options were rigid gas permeable rgp or gp contact lenses and implantation of. Ectasia prevalence can be decreased by determining risk factors which lead to post lasik corneal ectasia. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and postlasik ectasia. Treating post lasik ectasia with corneal crosslinking. 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. Corneal ectasia is a serious postoperative complication of lasik that is characterized by a progressive increase in corneal curvature.
Corneal ectasia is one of the rare yet potentially devastating complications. Treatment options are available with keratoplasty as the last resort. Corneal collagen crosslinking for ectasia after lasik and. Aug 16, 2015 lasik leads to significant and permanent biomechanical weakening of the cornea, which may lead to a sightrobbing complication known as post lasik corneal ectasia. 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. Both rigid and soft contact lenses can potentially alter the corneas shape. Routine lasik and cxl corneal ectasia after laser refractive surgery is rare. Stoneciphers patient returned in 2007 for additional treatment but showed signs of keratoectasia source. Corneal ectasia after photorefractive keratectomy prk has only been occasionally reported, and its incidence has not been assessed. There is also the potential to gain added benefit by combining. The medical literature contains reports of late onset ectasia occuring several years after lasik. Similarly, in the case of corneal ectasia, there is a tendency to get worse over time.
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. The study evaluated the effect of cxl in the treatment of ectasia after lasik and prk with a followup period of up to 62 months mean, 25 months. Topographical features and surgical parameters of those patients were evaluated. Postlasik ectasia treated with intrastromal corneal ring segments. Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for. Features and prognosis were evaluated in all patients with. I think that the majority, more than 90% of the postlasik ectasias have genetic keratoconus, dr. Postlasik corneal ectasia is thought to occur when the surgery reduces the stromas structural integrity to a level too low to maintain corneal shape and curvature. The lasik procedure permanently weakens and thins out the cornea, resulting in progressive changes in the cornea such as steepening or bulging, called ectasia. Quite possibly no other complication fills lasik surgeons with as much dread as corneal ectasia. Corneal ectasia is a serious complication of laser in situ keratomileusis lasik. Corneal collagen crosslinking for corneal ectasia of post. Post lasik ectasia treatment for post lasik side effects. 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.
Iatrogenic keratectasia ectasia is one of the most feared and dreaded complications of lasik. One histopathologic study looked at 12 ectatic corneas after lasik that. Scleral lenses are definitely lifesavers when it comes to correcting the condition of postlasik corneal ectasia. Corneal ectasia occurs when the inner layers of your cornea become weak, causing the cornea to change shape, protrude forward and distort your vision. 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. Mcdonald even though prk poses a significantly lower risk of corneal ectasia than does lasik, some corneas are too thin to undergo either procedure, according. Although ectasia is a risk more related to lasik than. Dec 18, 2012 corneal ectasia following lasik surgery causes changes in the shape of the cornea and can lead to decreased vision. Postlasik ectasia treated with intrastromal corneal ring segments and corneal crosslinking kay lam, md, dan b. Post surgical ectasia is a condition resembling keratoconus but comes from a different origin. Corneal crosslinking treats ectasia after refractive surgery.