Post-LASIK Ectasia

One of the most devastating consequences of LASIK eye surgery may be development of ectasia. As the laser removes corneal tissue, it can either cause, or hasten the natural progression of a patient's cornea to bulge. Unfortunately, there are times when no one could foresee this event occurring. As our understanding of cornea has dramatically improved in the LASIK era and advanced diagnostic equipment such as the Visante omni allow better evaluation of patients and their candidacy for LASIK eye surgery.

The incidence of post LASIK ectasia or "lectasia" is estimated at 1 in 1,000 eyes. But that was a high estimate of the earlier days of LASIK. These patients typically present several years later with ectasia. Therefore around 2003 a larger volume of patient with lectasia presented with a serious concern to the ophthalmic community. Task forces from the American Society of Cataract and Refractive Surgery and the American Academy of Ophthalmology were formed to investigate. With increased awareness and improved diagnostic equipment, the incidence of lectasia seems to have significantly decreased.

Many different hypothesis were made and models are made. It seems to be generally accepted that when LASIK is performed a minimum of 250 microns of remaining stromal tissue must remain. I will be presenting a case of post-LASIK ectasia here. The patient underwent LASIK surgery at another facility with another surgeon. The patient was unfortunately, not properly diagnosed as having keratoconus pre-LASIK surgery.

Pre-LASIK corneal topogrphy of a patient with keratoconus

A fifty six year old male patient with history of initial refractive errors of -0.50-3.00x050 right eye and -0.75-2.25x115 left eye with pre LASIK corneal topographies as noted above. Patient underwent LASIK eye surgery elsewhere. The patient later underwent 2 further enhancement procedures for correction of residual refraction in the right eye and one enhancement procedure in the left eye. Patient presented for second opinion in regards to his progressively declining vision. The Visante image below was able to demonstrate that despite the residual stromal tissue of at least 300 microns, ectasia of the cornea was clearly notable. Patient underwent a corneal transplant surgery for the right eye and was fitted with hard contact lens in the left eye.

Corneal ectasia post-LASIK despite the residual stromal bed of 300 plus microns

Page last edited 07/04/11