Corneal ectasia is a condition resembling keratoconus but comes from a different origin. Citeseerx document details isaac councill, lee giles, pradeep teregowda. Postlasik ectasia associated with pigmentary glaucoma. Thirtyone eyes of 24 patients with moderate to severe keratoconus and post lasik ectasia stages ii and iii of amslerkrumeich classification were included. 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. Collagen crosslinking cxl, gp lenses, scleral lenses, and hybrid lenses have been shown to be an effective treatment for keratoconus and post lasik ectasia. 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. To report late onset corneal ectasia following myopic lasik. Risk factors and prognosis for corneal ectasia after lasik j. Keywords corneal ectasia, intracorneal ring segment, postlasik.
One study found that all patients who develop iatrogenic ectasia post lasik had at least one predictable risk factor. Treating postlasik ectasia with corneal crosslinking. 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. This article is the first to describe and report on outcomes of performing cxl performed under a previous lasik flap. The case below is a case of a patient that i share with my good friend and colleague jeffery ing, md of stockton, ca. Decreasing vision after laserassisted insitu keratomileusis lasik history of present illness.
Topographical features and surgical parameters of those patients were evaluated. To report the incidence of postoperative ectasia after laser in situ keratomileusis lasik. Corneal ectasia is a severe complication occurring after lasik surgery. 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 of the cornea is one of the most severe complications of lasik laser in situ keratomileusis. Ten eyes of seven patients developed postlasik ectasia. Clinical grading of post lasik ectasia related to visual limitation and predictive factors for vision loss. Internal pressure from within the eye can cause expansion or distension of the cornea. Eye freedom after lasik, the cornea has been made thinner.
Post lasik ectasia was considered as increasing myopia with or without developing astigmatism, reduction of uncorrected visual acuity. Keratoconus and corneal ectasia after lasik request pdf. 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. Oculus pentacam interpretation manual pdf download.
Features and prognosis were evaluated in all patients with ectasia. A special gas permeable contact or scleral lens will be needed to restore lost vision. Pdf risk factors for post lasik ectasia yuri mercado. Corneal ectasia is a serious complication of laser in situ keratomileusis lasik. Almost invariably the cause is refractive eye surgery, most commonly lasik but also prk. Bradley randleman, md, buddy russell, fclsa, michael a. Eyeworld getting schooled on pta for ectasia prevention. Post lasik ectasia, ectasia, lasik, visante, visante omni, pentacam. Probability model of the inaccuracy of residual stromal thickness prediction to reduce the risk of ectasia after lasik part i.
Post lasik ectasia department of ophthalmology university of iowa. Before corneal refractive surgery such as lasik, smile, and prk, people must be examined for. The original lasik surgeon diagnosed ectasia and recommended the placement of intacs addition technology, des plaines, il. Management of post laser in situ keratomileusis ectasia. Ectasia prevalence can be decreased by determining risk factors which lead to post lasik corneal ectasia. The 2 main risk factors for post lasik keratectasia are a residual corneal bed of 250. Results in irregular astigmatism with accompanying blurred andor distorted vision. The lasik procedure permanently weakens and thins out the cornea, resulting in progressive changes in the cornea such as steepening or bulging, called ectasia. 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. Histopathological analysis of postlaserassisted in situ. Corneal collagen crosslinking for ectasia after laser in. Pdf postlasik ectasia associated with pigmentary glaucoma. Patient had corneal refractive stability for five years after lasik. 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.
We report the tear cytokine profile and in vivo confocal microscopy ivcm findings in eyes with ple. High myopia as a risk factor for post lasik ectasia. Aim corneal keratectasia is one of the complications associated with laser in situ keratomileusis lasik that results in vision impairment. Treatment options are available with keratoplasty as the last resort. Keratectasia is one of the most feared and dreaded complications of lasik. We evaluated clinical safety and longterm efficacy of topographyguided excimer laser enhancement combined with higher variable fluence and pattern refractive cxl as. Managing corneal ectasia prior to keratoplasty oculus pentacam. In vivo confocal microscopy and tear cytokine analysis in. To identify factors that can lead to corneal ectasia after laser in situ kerato mileusis lasik. Regardless, he said that corneal crosslinking is the proper procedure to perform on somebody who has ectasia. The pathogenesis of post lasik ectasia ple remains underexplored. Risk profiles of ectasia after keratorefractive surgery.
The advent of refractive surgery allowed for great advances in the understanding. Pdf clinical grading of postlasik ectasia related to. Management of post laser keratomileusis ectasia with. Risk factors and prognosis for corneal ectasia after 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. Ectasia after lasik postlasik keratoconus corneal ectasia.
Combined topography guided prk and corneal cross linking could represent an alternative treatment for post lasik ectasia. Orbscan of the right and left eyes of a patient before lasik. Post lasik ectasia treatment for post lasik side effects. Photographs, topographies, and videos of patients with ectasia after lasik. Postlasik ectasia, refractive surgery complications. Five years ago, my team in athens, greece, introduced the concept of performing. Author links open overlay panel qi wan dan wang hongquan ye. Corneal ectasia after photorefractive keratectomy prk has only been occasionally reported, and its incidence has not been assessed. Validation of the ectasia risk score system for preoperative laser in situ keratomileusis screening. The cornea is too thin from the amount of corneal tissue that was removed with the laser procedure or a prior corneal disease and begins to protrude forward. Preventing ectasia with crosslinking after prk or lasik. This suggests that the higher risk of developing ectasia after lasik compared with. It is associated with progressive corneal steepening, an increase in myopia and astigmatism, and a decrease in uncorrected and corrected visual acuity. Vision in the right eye was never as good as the left eye even after.
Post lasik corneal ectasia is a rare but a serious complication which leads to decreased visual acuity. 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. Corneal ectasia is a rare but serious post operative complication that usually occurs after uneventful excimer laser surgery, i. Patients with forme fruste keratoconus have a high risk for developing iatrogenic ectasia after lasik 11. 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.
View and download oculus pentacam interpretation manual online. Threestep treatment of keratoconus and postlasik ectasia. Known risk factors for post lasik corneal ectasia in miami. Corneal ectasia induced by laser in situ keratomileusis. Late onset corneal ectasia after lasik surgery sciencedirect. 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. Patients left eye was treated with simultaneous topography guided photorefractive. This 56yearold woman presented status post bilateral lasik for myopia at an outside institution.
Incidence, risk factors, and treatment for ectasia, keratoconus after lasik. Late onset corneal ectasia after lasik surgery core. Characterization of the effect of intracorneal ring segment in corneal. Corneal ectasia post lasik complication new treatment info. View fulltext html download pdf track your manuscript. Corneal ectasia induced by laser in situ keratomileusis ioannis g. To evaluate the risk factors for post laser in situ keratomileusis lasik ectasia. Ideal sources for wikipedia s health content are defined in the guideline wikipedia. The patient had had lasik performed elsewhere and subsequently developed ectasia. Iatrogenic corneal ectasia after laser in situ keratomileusis lasik is a rare but devastating complication of refractive surgery. Comment on undertheflap crosslinking and lasik in early. Amin ashrafzadeh, md post lasik ectasia evaluated with.
Postlaser in situ keratomileusis ectasia touchophthalmology. Management of corneal ectasia after lasik with phototherapeutic. Pdf incidence and clinical characteristics of post lasik ectasia. Digital journal of ophthalmology 2009 volume 15, number 1 february 23, 2009 printer friendly download pdf.
A registry for reporting cases of ectasia after lasik had its debut recently. The appearance and progression of postlasik ectasia are similar to a degenerative disease of the cornea called keratoconus. Article information, pdf download for characterization of the effect of. Corneal ectasia is a rare but serious postoperative complication that usually occurs after. Post surgical ectasia is a condition resembling keratoconus but comes from a different origin.
Citeseerx open access management of post laser in situ. Ectasia after lasik american academy of ophthalmology. The trip database provides clinical publications about evidence. Pressure inside the eye called intraocular pressure iop, which pushes on the back surface. She reported that after she underwent lasik, the vision in her left eye was great and had remained. Studies suggest it may occur in roughly one of every 2,000 lasik procedures. Thirtymonth results after the treatment of postlasik ectasia with. Management of post laser in situ keratomileusis ectasia with simultaneous topography guided photorefractive keratectomy and collagen crosslinking.
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