Bilateral Keratectasia After Photorefractive Keratectomy

Abstract

PURPOSE: To report the clinical features, management, and outcome of a patient who developed bilateral ectasia after photorefractive keratectomy (PRK). METHODS: Case report of a 35-year-old man who underwent bilateral PRK. Preoperative uncorrected visual acuity was 20/200 in the right eye and 20/100 in the left eye. The patient's history was unremarkable and he denied a family history of ocular disorders. RESULTS: Two weeks after surgery, the patient presented with loss of visual acuity in both eyes. Uncorrected visual acuity was 20/80 in the right eye and 20/200 in the left eye. Objective refraction could not be obtained. Slit-lamp microscopy showed corneal thinning in both eyes. After examining the patient's family, his sister was found to have clinical and topographic keratoconus. CONCLUSIONS: Ectasia is a rare complication of PRK. We report the occurrence of bilateral ectasia after PRK in a patient with asymmetric bowtie topographies. We recommend that refractive surgery, even surface techniques such as PRK, be avoided in patients with a family history of keratoconus. [J Refract Surg. 2007;23:941-943.]

One-year follow-up of toric intraocular lens implantation in forme fruste keratoconus

“…Some authors avoid corneal refractive surgery in patients who are keratoconus suspects or those with a family history of keratoconus. 14 We believe that in these cases and in carefully selected cases of nonprogressive keratoconus, toric IOLs may be an excellent alternative.…”

Refractive surgery for keratoconus

“…Despite these encouraging reports most surgeons remain very wary of photorefractive keratectomy in forme fruste or keratoconic corneas, together with the uncertainty of long-term stability, especially in the light of reports of keratectasia after PRK in normal, forme fruste and keratoconic corneas and patients with a family history of keratoconus. 9,10,18,19 Kasparova and Kasparov 20 introduced the novel concept of combined photorefractive keratectomy and phototherapeutic keratectomy (PTK) in keratoconus, the idea being that the photorefractive keratectomy part of the treatment could influence the anterior corneal layers and block the pathological process, stimulating regenerative processes and preventing progression of keratoconus. This was based on their theory that after excimer laser treatment, the ablated layers are replaced by a new fibrocellular membrane with increased solidity and rigidity, which may then act like a 'corset' to the cornea, preventing progression.…”

March consultation # 3

“…Nevertheless, I would also perform corneal topography to rule out ectasia and evaluate the potential for further refractive correction. 2,3 Monoblock IOLs have been reported to decenter or tilt when placed in the bag. 4 Moreover, plate-haptic IOLs can luxate into the vitreous cavity after Nd:YAG capsulotomy.…”