Lasik Interface Opacity Associated With Post Lasik Ectasia

To report a case of a 46 year old male presenting with bilateral corneal ectasia associated with LASIK/stroma interface opacity occuring approximately 13 years post LASIK. The cornea ectasia has progressed despite corneal collage cross linking. The underlying aetiology of the LASIK flap/stroma interface remains unknown and there does not appear to be similar case reports previously in the online literature.

LASIK was performed for low myopia right -1.65/-0.44x76 and left -1.62/-0.24x54. A reduction of vision 13 years later led to a diagnosis of bilateral corneal ectasia post LASIK which was more advanced in the left eye as well as a opacity at the LASIK flap/stroma interface in the right eye which later developed in his left eye. The opacity found was not associated with any infection or inflammation and did not respond to topical steroids. 

Information from this case was gathered from past ocular history as well as various ophthalmology clinic hospital visits between 2022 and 2025. Comprehensive reviews were performed over this time including reviews by ophthalmologists, optometrists. The patient underwent extensive investigation with anterior segment OCT, corneal topography and anterior segment photographs in order to monitor progression of corneal ectasia and corneal opacity.

Between 2021 and 2022 there had been a 0.5D change to the steepest K in the right eye and a 4D increase in steepest K reading for left eye. Corneal cross linking was performed in February 2023 for right eye and September 2023 for left eye. Subjective refraction in May 2023 was right plano/-4.50x70 (6/12) and left +1.00/-6.00x98 (6/6-2). Despite blateral corneal cross linking in 2023 there has been progression of the corneal ectasia in both eyes. A corneal opacity which was initially present in the right eye  later developed in the left eye. The aetiology of the opacity is unknown. The latest subjective refraction from January 2025 is right +8.00/-13.00x73 (6/12) and left +3.25/-15.00 x95 (6/9.5+2) with add +1.00DS and reads N6.

Post LASIK corneal ectasia can develop many years from the date of initial LASIK surgery. Corneal interface opacities can also develop however the aetiology remains unknown and appeared stable at the last outpatient review in February 2025. There does not appear to be any literature on the underlying possible aetiology of the corneal interface opacities previously published.