Post-LASIK ectasia explained

Post-LASIK ectasia is a condition similar to keratoconus where the cornea starts to bulge forwards at a variable time after LASIK, PRK, or SMILE corneal laser eye surgery.^[1] However, the physiological processes of post-LASIK ectasia seem to be different from keratoconus. The visible changes in the basal epithelial cell and anterior and posterior keratocytes linked with keratoconus were not observed in post-LASIK ectasia.^[2] __TOC__

Risk factors

Before corneal refractive surgery such as LASIK, SMILE, and PRK, people must be examined for possible risk factors such as keratoconus.^[3]

Abnormal corneal topography compromises of keratoconus, pellucid marginal degeneration, or forme fruste keratoconus with an I-S value of 1.4 or more^[4] is the most significant risk factor. Low age, low residual stromal bed (RSB) thickness, low preoperative corneal thickness, and high myopia are other important risk factors.^{[5] [6]}

Treatments

Treatment options include contact lenses,^{[7] [8]} intrastromal corneal ring segments, custom topography-guided transepithelial PRK combined with corneal collagen cross-linking,^[9] or corneal transplant.

When cross-linking is performed only after the cornea becomes distorted, vision remains blurry even though the disease is stabilised. As a result, combining corneal collagen cross-linking with LASIK ('LASIK Xtra') aims to strengthen the cornea at the point of surgery and may be useful in cases where a very thin cornea is expected after the LASIK procedure.^[10] This would include cases of high spectacle power and people with thin corneas before surgery. Definitive evidence that the procedure can reduce the risk of corneal ectasia will only become available a number of years later as corneal ectasia, if it happens, usually occurs in the late post-operative period. Some study show that combining LASIK with cross-linking adds refractive stability to hyperopic treatments and may also do the same for very high myopic treatments.^{[11] [12]}

In 2016, the FDA approved the KXL system and two photoenhancers for the treatment of corneal ectasia following refractive surgery.^[13]

Notes and References

1. Web site: Ectasia After LASIK. American Academy of Ophthalmology.
2. Web site: 15 December 2020. What Is Keratoconus? Everything You Need to Know. 15 December 2020. Clearview Vision Institute.
3. News: Medical Mystery: Preparation for surgery revealed cause of deteriorating eyesight. The Washington Post . Peter . Finn . 20 December 2012 .
4. Rabinowitz. YS. McDonnell. PJ. Computer-assisted corneal topography in keratoconus.. Refractive & Corneal Surgery. 1989. 5. 6. 400–8. 10.3928/1081-597X-19891101-10 . 2488838.
5. Kohlhaas. M. Spoerl. E. Schilde. T. Unger. G. Wittig. C. Pillunat. LE. Biomechanical evidence of the distribution of cross-links in corneas treated with riboflavin and ultraviolet A light.. Journal of Cataract and Refractive Surgery. February 2006. 32. 2. 279–83. 16565005. 10.1016/j.jcrs.2005.12.092. 30983601.
6. Randleman. JB. Banning. CS. Stulting. RD. Corneal ectasia after hyperopic LASIK.. Journal of Refractive Surgery. January 2007. 23. 1. 98–102. 17269252. 10.3928/1081-597X-20070101-17.
7. Marsack. Jason D.. Parker. Katrina E.. Applegate. Raymond A.. Performance of Wavefront-Guided Soft Lenses in Three Keratoconus Subjects. Optometry and Vision Science. December 2008. 85. 12. E1172–E1178. 10.1097/OPX.0b013e31818e8eaa. 19050464. 2614306.
8. Marsack. JD. Parker. KE. Niu. Y. Pesudovs. K. Applegate. RA. On-eye performance of custom wavefront-guided soft contact lenses in a habitual soft lens-wearing keratoconic patient.. Journal of Refractive Surgery. November 2007. 23. 9. 960–4. 18041254. 10.3928/1081-597X-20071101-18.
9. Lam. Kay. Rootman. Dan B.. Lichtinger. Alejandro. Rootman. David S.. Post-LASIK ectasia treated with intrastromal corneal ring segments and corneal crosslinking. Digital Journal of Ophthalmology . 6 January 2013. 19. 1. 1–8. 10.5693/djo.02.2012.10.001. 23794955. 1542-8958. 3689440.
10. Web site: Stephenson. Michelle. LASIK Xtra: Is It for Everyone?. Review of Ophthalmology. Jobson Medical Information LLC. 2014.
11. Kanellopoulos. AnastasiosJohn. Pamel. GregoryJ. Review of current indications for combined very high fluence collagen cross-linking and laser in situ keratomileusis surgery. Indian Journal of Ophthalmology. 2013. 61. 8. 430–2. 10.4103/0301-4738.116074. 23925331. 3775081 . free .
12. https://www.chuvision.com/lasik-minneapolis/ LASIK Treatment
13. Web site: Highlights of Prescribing Information: PHOTREXA VISCOUS (riboflavin 5'-phosphate in 20% dextran ophthalmic solution) 0.146% for topical ophthalmic use PHOTREXA (riboflavin 5'-phosphate ophthalmic solution) 0.146% for topical ophthalmic use For use with the KXL® System. U.S. Food and Drug Administration. 5–14.