ESCRS - CC01.05 - Two Cases Of Asymmetric Progressive Corneal Ectasia Following Femtosecond Laser-Assisted Small-Incision Lenticule Extraction (Relex Smile).

Two Cases Of Asymmetric Progressive Corneal Ectasia Following Femtosecond Laser-Assisted Small-Incision Lenticule Extraction (Relex Smile).

Published 2025 - 43rd Congress of the ESCRS

Reference: CC01.05 | Type: Case Report | DOI: 10.82333/8h3e-ek19

Authors: Erika Eskina* 1 , Victoria Parshina 2 , Teresa Tsai 3 , Stephanie C. Joachim 3

1Refractive, ‘Sphere’ Eye Surgery Clinic,Moscow,Russian Federation;Experimental Eye Research Institute,University Eye Hospital, Ruhr-University Bochum,Bochum,Germany, 2Refractive,‘Sphere’ Eye Surgery Clinic,Moscow,Russian Federation, 3Experimental Eye Research Institute,University Eye Hospital, Ruhr-University Bochum,Bochum,Germany

Purpose

Identify additional risk factors for the development of corneal ectasia after refractive lenticule extraction

Setting

Preoperative data as well as treatment parameters, followed by patients agreement are presented. The risk of postoperative ectasia evaluated using Belin-Ambrosio and SIRIUS software, progression estimated with the ABCD Belin scale and posterior and anterior corneal indices. Percent tissue altered (PTA) and Ectasia Risk Factor Score System (ERSS) were evaluated. 

Report of case

A 18-year old man, with stable refraction and difference between the both eyes since childhood with normal Scheimflug tomography and Placido topography had undergone the Keratorefractive Lenticule Extraction (KLEX) procedure OD. Preop data OD: -3.62 cyl-0.25 ax 170, pachymetry 545 μm AL 25.64 mm, K-readings 40.75 and 41.46 and OS: cyl-0.5 ax 170, pachymetry 552 μm, AL 24.39 mm, K-readings 40.74 and 41.74, maximum lenticule thickness OD 85 μm, Cap 130 μm, PTA 39%, residual stromal thickness (RST) 330 μm, ERSS was 3. At 30 months postop, the patient presented with decreased VA and ectatic process in the posterior corneal surface А2В4С3D1. After crosslinking (CXL) procedure according to Dresden Protocol we observe a 12 months stable refraction and keratometric parameters.

A 20-year old man with stable refraction with normal Scheimflug tomography and Placido topography underwent the KLEX procedure OD and OS. Preop data OD: -8.25 cyl-1.0 ax 0, pachymetry 589 μm, AL 26.35 mm , K-readings 44.44 and 45.44 and OS: -7.5 cyl-0.75 ax 10, pachymetry 591 μm, AL 26.32 mm, K-readings 43.94 and 44.95, maximum lenticule thickness OD 169 μm, Cap 120 μm, PTA 49%, RST 300 μm, ERSS was 4, OS 156 μm, Cap 120 μm, PTA 47%, RST 315 μm, ERSS was 3. At 6 and 9 months postop, we noted an increase in posterior corneal elevation OD without BCVA changes. CXL OD was performed.

Conclusion/Take home message

These cases confirm the need of a complex approach to predict the risk for postoperative corneal ectasia after KLEX procedure. Normal corneal topography and tomography as well as RST of more than 300 μm are not sufficient to avoid an ectatic process after LVC. All the available data including asymmetrical refraction, biochemical markers of KC, PTA and ERSS should be thoroughly analyzed.