Crosslinking Epi-On As A Treatment For Progressive Post Laser In Situ Keratomileusis Ectasia: A Case Report.

Published 2024 - 42nd Congress of the ESCRS

Reference: PO791 | Type: Poster | DOI: 10.82333/1tc4-tj93

Authors: Joel Roura Turet* ¹ , Mauricio Kuzmuk ¹ , Cristobal Rosenberg Pacareu ¹ , Montserrat Lopez Lopez ¹ , Núria Planas Domenech ¹ , Noemí Barnils Garcia ¹

¹Hospital Universitario Bellvitge,Hospitalet de Llobregat,Spain

Purpose

To report a case of post-keratomileusis in situ (post-LASIK) ectasia managed with crosslinking (CXL) Epi-on, with subsequent stability of progression, and with a good final visual acuity with scleral contact lenses.

Setting

Post LASIK ectasia is a serious complication, with an incidence between 0.04-0.09%. It is manifesting as a progressive thinning of the cornea, accompanied by increased myopia and astigmatism. There are several options for the treatment with CXL as a preferred, whose primary goal is to stop the progression of the ectasia. It can be combined with rigid contact lenses or intracorneal ring segments, to modulate the cornea and improve visual acuity. In advanced cases, keratoplasty may be considered.

Methods

A fifty-four-year-old woman with a history of myopic LASIK in both eyes, referred to our service for evaluation of post-LASIK corneal ectasia in the right eye, evidenced by topography (K1 38,18D; K2 49,23D; cylinder (Cyl.) -11,05D Ax 81º; minimum thickness of 500 μm), with a best corrected visual acuity of 20/63. There were no alterations in biomicroscopy or signs of ectasia in the contralateral eye. During follow- up, progression of ectasia and astigmatism was evident, with a decrease in pachymetry to 433 μm, which is why it was decided to perform CXL Epi-on.

Results

Iontophoresis assisted corneal CXL was performed in the right eye. Two months after the intervention, doubtful topographic progression was noted (K1 39.89D; K2 50.8D; Cyl. -10,91D Ax 82º; minimum thickness 467mm) which was not confirmed during subsequent follow-ups (at 4, 6 and 10 months), with a final topography: K1 39.86D; K2 51.1D; Cyl. -11.33D Ax 80º, with a minimum thickness of 484mm. Visual acuity remained stable, without improvement. The patient was recommended adapting scleral lenses, improving visual acuity to 20/25 with good adaptation and tolerance of the lenses.

Conclusions

Crosslinking is a very useful technique to stop the progression of post-Lasik corneal ectasia, without clear improvement in visual acuity, in corneas with minimum thicknesses greater than 400 μm.