Post lasik ectasia department of ophthalmology university of iowa. Risk factors and prognosis for corneal ectasia after lasik. A special gas permeable contact or scleral lens will be needed to restore lost vision. Kymionis gd, diakonis vf, kalyvianaki m, portaliou d, siganos c, kozobolis vp, pallikaris ai. Results in irregular astigmatism with accompanying blurred andor distorted vision. Management of post laser in situ keratomileusis ectasia with simultaneous topography guided photorefractive keratectomy and collagen crosslinking george d kymionis 1, dimitra m portaliou, 1, vasilios f diakonis 1, alexandra e karavitaki 1, sophia i panagopoulou 1, mirko r jankov ii 2, efekan coskunseven 3. Known risk factors for post lasik corneal ectasia in miami. The lasik community has taken the issue very, very seriously.
If corneal ectasia develops, there are many options available for treatment before an eye. Persons experiencing post lasik ectasia should seek the advice of a physician. She reported that after she underwent lasik, the vision in her left eye was great and had remained. Validation of the ectasia risk score system for preoperative laser in situ keratomileusis screening. Although post lasik 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. Upon completion of this issue, you should be able to. Dec 15, 2004 a post lasik ectasia patient who was caught early bottom topography. Combined topography guided prk and corneal cross linking could represent an alternative treatment for post lasik ectasia. The advent of refractive surgery allowed for great advances in the understanding. Topographyguided prk and crosslinking in eyes with. Longterm followup of intacs for postlasik corneal ectasia.
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. Author links open overlay panel olivier richoz md 1 nikolaos mavrakanas. View fulltext html download pdf track your manuscript. Postlaser in situ keratomileusis ectasia touchophthalmology. There are numerous reports of corneal ectasia that developed after lasik in myopic eyes, occurring in most of cases 1 year after surgery, 4,5 although late onset sometimes after 10 years or more. The appearance and progression of post lasik ectasia are similar to a degenerative disease of the cornea called keratoconus. We report the tear cytokine profile and in vivo confocal microscopy ivcm findings in eyes with ple. Management of postlasik corneal ectasia with intacs inserts. Decreasing vision after laserassisted insitu keratomileusis lasik history of present illness. In a retrospective study on post prk ectasia patients, 9 eyes of 7 patients were included, in addition to 20 eyes of patients from the literature. Bradley randleman, md, buddy russell, fclsa, michael a. Ectasiawhether postlasik or keratoconushas always been an unwelcome occurrence. 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. Newer treatment modalities have been developed to tackle this rare, yet devastating complication of refractive surgery.
Keratectasia is one of the most feared and dreaded complications of lasik. Topography examination revealed deterioration of corneal ectasia. Surgical techniques are evolving for the treatment of both keratoconus and post lasik ectasia. 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.
Ectasia after lasik american academy of ophthalmology. Studies suggest it may occur in roughly one of every 2,000 lasik procedures. Also, for postlasik corneal ectasia, the riboflavin diffusion may be reduced due to the flap interface, affecting. Corneal collagen crosslinking for ectasia after lasik and photorefractive keratectomy. Probability model of the inaccuracy of residual stromal thickness prediction to reduce the risk of ectasia after lasik part i.
Corneal ectasia is a rare but serious post operative complication that usually occurs after uneventful excimer laser surgery, i. The corneal shape has become more regular, but the patient needs to remain on the drops to keep the effect. Aim corneal keratectasia is one of the complications associated with laser in situ keratomileusis lasik that results in vision impairment. Management of post lasik corneal ectasia with intacs inserts. One study found that all patients who develop iatrogenic ectasia post lasik had at least one predictable risk factor. Vision in the right eye was never as good as the left eye even after. Thirtyone eyes of 24 patients with moderate to severe keratoconus and post lasik ectasia stages ii and iii of amslerkrumeich classification were included. Evaluation of new corvis st parameters in normal, postlasik. Late onset corneal ectasia after lasik surgery sciencedirect. Corneal tomographic features of postrefractive surgery ectasia. To report late onset corneal ectasia following myopic lasik.
Post lasik ectasia of the cornea is one of the most severe complications of lasik laser in situ keratomileusis. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and post lasik ectasia. Risk of post prk ectasia was calculated using the ectasia risk score system erss for. Mar 30, 2020 evaluation of new corvis st parameters in normal, postlasik, postlasik keratectasia and keratoconus eyes. Pdf management of post laser in situ keratomileusis ectasia.
A postlasik ectasia patient who was caught early bottom topography. Nov 12, 2018 post lasik corneal ectasia is a rare but serious late postoperative complication. Late onset corneal ectasia after lasik surgery core. Oneyear followup of corneal confocal microscopy after corneal crosslinking in patients with post laser in situ keratomileusis ectasia and keratoconus. Why cataract and refractive surgeons need the pentacam why. The lasik procedure permanently weakens and thins out the cornea, resulting in progressive changes in the cornea such as steepening or bulging, called ectasia. Threestep treatment of keratoconus and postlasik ectasia. Pdf risk factors for post lasik ectasia yuri mercado.
Managing corneal ectasia prior to keratoplasty oculus pentacam. This 56yearold woman presented status post bilateral lasik for myopia at an outside institution. Corneal collagen crosslinking for ectasia after lasik and. Herein, we describe a case of post lasik ectasia with high myopia as the identifiable risk factor. Mar 05, 2014 keratectasia is one of the most feared and dreaded complications of lasik. A retrospective nonrandomized study involved preoperative lasik data from 23 post lasik ectasia. Corneal ectasia vision distortion is there a clear solution. Regardless, he said that corneal crosslinking is the proper procedure to perform on somebody who has ectasia. Deep anterior lamellar keratoplasty in postlaser in situ. Another report presented the case of a patient who developed post lasik ectasia despite being considered at low risk based on preoperative topographic evaluation. Eye freedom after lasik, the cornea has been made thinner. Ectasia after lasik postlasik keratoconus corneal ectasia.
View and download oculus pentacam interpretation manual online. High myopia as a risk factor for post lasik ectasia. Methods this retrospective study included agematched 7 14 eyes post lasik controls plcs and 6 12 eyes ple subjects. Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for. Post lasik corneal ectasia is a rare but serious late postoperative complication. 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. Patient had corneal refractive stability for five years after lasik. Eyeworld treating postlasik ectasia with corneal crosslinking. Postlasik ectasia, refractive surgery complications. 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 post lasik ectasia. The original lasik surgeon diagnosed ectasia and recommended the placement of intacs addition technology, des plaines, il. The clinical onset of keratoectasia can occur months or even years after the surgery.
The 2 main risk factors for post lasik keratectasia are a residual corneal bed of 250. In vivo confocal microscopy and tear cytokine analysis in. Methods in this prospective nonrandomized clinical trial, 10 eyes of 7 patients with postlasik corneal ectasia 2 men and 5 women aged 33 to 46 years. They are helpful in restoring vision, supporting in corneal healing and improving overall quality of life of complex corneal diseases patients.
In fact, the surgical outcomes are not always as expected. Ideal sources for wikipedia s health content are defined in the guideline wikipedia. 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. Internal pressure from within the eye can cause expansion or distension of the cornea. 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. Thirtymonth results after the treatment of postlasik. Post lasik corneal ectasia is a rare but a serious complication which leads to decreased visual acuity. The causes of ectasia are manifold, but a significant rise in post lasik ectasia has been seen. Postoperative corneal ectasia has been estimated to occur in 0.
Management of corneal ectasia after lasik with phototherapeutic. Oculus pentacam interpretation manual pdf download. The reason for kerasoft 3 lens fit, the number of trial lenses required for ideal fit, centration, movement, and stabilization of the contact lens, uncorrected, spectaclecorrected. Characteristics of corneal ectasia after lasik for myopia. Here are links to possibly useful sources of information about postlasik ectasia. 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. Post lasik ectasia treatment for post lasik side effects. Thirtymonth results after the treatment of postlasik ectasia with. The exact risk for post lasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. Orbscan of the right and left eyes of a patient before lasik. Consent for offlabel therapeutic use for postlasik. We are now being told, however, that the elevation of the posterior surface is important in diagnosing early keratoconus and postlasik ectasia. Pressure inside the eye called intraocular pressure iop, which pushes on the back surface. Postlasik ectasia was considered as increasing myopia with or without.
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. I became involved in the crosslinking technique out of desperation, trying to manage post lasik ectasia patients, he explains. The outcomes measured were visual response, change of corrected distance visual acuity cdva, and cdva 1 year after cxl. Corneal ectasia occurs when the inner layers of your cornea become weak, causing the cornea to change shape, protrude forward and distort your vision. I used intacs to treat keratoconus for more than 10 years, and patients were thrilled with the change in their visual function. The exact risk for postlasik ectasia is unknown and difficult to estimate, given advances in lasik technology and treatment protocols. Post prk ectasia is much less prevalent than post lasik ectasia. 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.
Corneal ectasia post lasik complication new treatment info. A medline search for lasik and ectasia yielded 21 relevant articles published before may 2003 n 86 eyes, 59 patients. Post surgical ectasia is a condition resembling keratoconus but comes from a different origin. Iatrogenic keratectasia is a rare sightthreatening complication of the laser refractive surgery. 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. Digital journal of ophthalmology 2009 volume 15, number 1 february 23, 2009 printer friendly download pdf.
Evaluation of new corvis st parameters in normal, post. Prognostic factors for visual outcomes after crosslinking for. To evaluate the safety, efficacy, and oneye performance of kerasoft 3 contact lenses ultravision in ectatic corneal diseases. This condition, commonly referred to as post lasik ectasia, behaves in a manner similar to that of keratoconus. Though, the rate of post lasik ectasia is not proved yet, some various rates from 0. Treatment options are available with keratoplasty as the last resort. Management of post laser keratomileusis ectasia with. Ectasia prevalence can be decreased by determining risk factors which lead to post lasik corneal ectasia.
The cohort was divided into groups based on the change in cdva postoperatively. In the study cohort, the rate of post prk ectasia was 9 out of 31,045 eyes 0. 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. Post lasik corneal ectasia is a serious late postoperative complication. Pdf management of post laser in situ keratomileusis. This was a retrospective evaluation of clinical data. Keratoconus and corneal ectasia after lasik request pdf. Topographyguided prk and crosslinking in eyes with keratoconus and postlasik ectasia. The appearance and progression of postlasik ectasia are similar to a degenerative disease of the cornea called keratoconus. Author links open overlay panel qi wan dan wang hongquan ye. Managing and predicting ectasia research continues to reveal more about the efficacy of recently developed options for treating this devastating condition. To analyze the risk factors associated with a series of ectasia cases following photorefractive keratectomy prk and all published cases.
Evaluation of new corvis st parameters in normal, post lasik, post lasik keratectasia and keratoconus eyes. Risk factors and prognosis for corneal ectasia after lasik j. 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. Modern excimer laser refractive surgery attempts to correct refractive errors by altering the shape of the front surface of the cornea. After lasik, the cornea is structurally weakened, not only by the laser central stromal ablation, but also by the creation of the flap itself. The pathogenesis of post lasik ectasia ple remains underexplored. 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. 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. 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. Eyeworld getting schooled on pta for ectasia prevention. Treating postlasik ectasia with corneal crosslinking. The study cohort comprised 75 eyes from 50 patients with keratoconus or post lasik ectasia who underwent cxl. Easy calculation evaluates postlasik ectasia risk american. A registry for reporting cases of ectasia after lasik had its debut recently.