Management of corneal ectasia and cataract following photorefractive keratectomy

Abstract

A 42-year-old man was referred to our clinic 18 months after bilateral photorefractive keratectomy (PRK). He had been on topical prednisolone acetate for 12 months because of post-PRK grade 4 haze. On his first visit, visual acuity was limited to light perception in both eyes because of moderate haze, significant corneal ectasia, and a white cataract. A 2-step surgical approach was elected in both eyes. First, a deep anterior lamellar keratoplasty was performed. Six weeks later, phacoemulsification with intraocular lens implantation was performed. Compared with a triple procedure combining penetrating keratoplasty and cataract surgery in 1 stage, the 2-step approach may lower the risk for corneal graft rejection and reduce ametropia.

Analysis of ectasia after laser in situ keratomileusis: Risk factors

“…40 Confusing our understanding of the cause(s) of ectasia are case reports of the development of ectasia after PRK. 41,42 In these cases, the RST was not at issue because the eyes had RSTs within the ''safe'' range. This current reported series had 198 eyes with an RST less than 250 mm and 54 eyes with a residual thickness less than 225 mm; yet none developed ectasia.…”

Deep anterior lamellar keratoplasty using the big-bubble technique for keratectasia after laser in situ keratomileusis

“…9,10 Results in several studies [11][12][13] indicate that the visual outcomes after DALK are comparable to those after PKP in cases of keratoconus. In addition, recent studies [14][15][16] report promising results of DALK in cases of iatrogenic ectasia.…”

Deep anterior lamellar keratoplasty: Indications, surgical techniques and complications

“…The promising outcomes of DALK in the management of keratoconus have led some surgeons to believe that DALK would be a useful approach for iatrogenic keratectasia 25–27. The technique of DALK is very similar to that previously reported for keratoconus.…”