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Late onset post PRK-ectasia: case series
Session Title: Keratoconus and ectasia
Session Date/Time: Tuesday 08/10/2013 | 16:30-18:00
Paper Time: 16:46
Venue: Elicium 2 (First Floor)
First Author: : A.Barbara ISRAEL
Co Author(s): : R. Barbara L. Abdelaziz H. Garzozi
To report on late onset post laser in situ keratomileusis (Lasik) ectasia in 11 eyes of 9 patients. Onset of ectasia confirmed to be between 6-11 years post Lasik surgery.
Post-Lasik ectasia is the most feared complication following Lasik, occurring in the majority of cases within one year of surgery. An early diagnosis is crucial to provide appropriate management plan to halt its progression and consideration of visual rehabilitation by conservative or surgical means.
Our case series emphasises the late onset of ectasia and not the etiologic factors nor the management plan.
Ophthalmology unit, Hadassah Optimal Medical Center, Haifa, Israel.
Review of patient"s records revealed 11 eyes with late onset of post-Lasik ectasia.
In addition to full ophthalmic history and examination, the diagnoses was confirmed using corneal topographic mapping using Topcon placid topofraphy (Topcon, Japan), Orbascan II (Bausch & Lomb, USA), TMS 4 (Placido topography, Tomey, Japan). The thinnest point of the corneal thickness (CCT) was recorded.
We identified a total of 11 eyes with late onset ectasia. Two patients had bilateral ectasia while seven patients had only one eye affected.
In three eye, four eyes and two eyes the ectasia was diagnosed 6, 8 and 9 years postoperatively respectively. In one patient both eyes showed gradual deterioration of vision which started 9 years following surgery but ectasia was not diagnosed until 11 years after surgery.
The topographic maps were diagnostic of ectasia in 10 of 11 patients. In one patient the axial map was not typical of ectasia and the diagnosis was made by taking into consideration the loss of best spectacle corrected visual acuity (BSCVA), the increased astigmatism, the high anterior and posterior float.
Post-Lasik ectasia is under-reported. Articles that report on score for the development of post-Lasik ectasia are not long enough to elicit long-term onset. Most published articles describe late onset of ectasia being 3-4 years post surgery. In our series, ectasia was diagnosed in three eyes 6 years post-Lasik (two eyes of the same patient), four eyes 8 years post surgery, two eyes 9 years post surgery and two eyes 11 years after Lasik in the same patient.
The onset of ectasia may be delayed years postoperatively. Even patients who have successful surgery may develop ectasia in the future, hence early diagnosis is crucial to its management. Although management plan could be similar to keratoconus patients, nevertheless, ectasia patients are more demanding than patients with keratoconus, as ectasia patients have excellent BSCVA to begin with and undergone Lasik surgery to improve vision even further.
The aim is to stress the fact that even after 6 years of Lasik surgery one cannot be certain that the cornea will remain biomechanically stable and free of ectasia. This case series demonstrate the importance of examining post-Lasik patients many years after surgery and especially those complaining of vision deterioration.