Management Of Post Lasik Corneal Ectasia: About A Case.

Our objective is to remind the importance of the search for corneal ectasia risk factors and contraindications before performing refractive surgery, also to show the interest of scleral lenses in visual rehabilitation

We report the case of a patient with unilateral corneal ectasia that occurred several years after myopic refractive surgery by laser assisted in situ keratomileusis.

She benefited from a cross-linking followed by an adaptation in scleral lenses in order to stop the evolution of her ectasia and allow a visual improvement.

A 54-year-old woman with a history of high myopia, operated by refractive surgery (LASIK) on the right eye and phacoemulsification on the clear lens of the left eye in 2010, she presented in our consultation for lowering of progressive unilateral visual acuity evolving for several years in the right eye.

On clinical examination, the best visual acuity corrected to 1/20th P5 of the right eye (impregnable refraction) and 9/10th P3 of the left eye (-0.25 (-0.75 axis 30°).

Slit lamp examination finds a relatively clear cornea with an anterior protrusion and a Munson's sign.

The left eye finds a clear cornea with implant in the bag in place.

Examination of the conjunctiva objective signs of chronic allergy in both eyes Corneal topography (PENTACAM OCULUS) found in the right eye a very significant corneal bulge of the anterior and posterior face with corneal thinning opposite.

On questioning, pathological eye rubbing is noted as risk factors. The stopping of friction and the realization of a cross-linking followed by an adaptation in scleral lens in order to stop the progression of the ectasia and to reduce the chromatic optical aberrations induced, thus allowing a visual rehabilitation corrected to 6 / 10th P3 of the right eye.

Corneal ectasia after refractive surgery can develop regardless of the surgical technique used and regardless of the extent of ametropia. In our clinical case, it occurred several years after surgery and was favored by eye rubbing. The realization of a cross-linking followed by an adaptation in scleral lens is a recognized technique in the treatment of post-Lasik ectasia.

Corneal ectasia is a rare complication of refractive surgery, its management is essentially based on prevention, thanks to a meticulous and exhaustive pre-operative assessment in search of recognized risk factors for ectasia.