Pregnancy-related exacerbation of iatrogenic keratectasia despite corneal collagen crosslinking

Abstract

Iatrogenic keratectasia after laser in situ keratomileusis (LASIK) represents a serious complication of refractive laser surgery. We describe a woman who developed bilateral iatrogenic keratectasia during her first pregnancy 26 months after LASIK. Corneal collagen crosslinking (CCL) with riboflavin and ultraviolet-A was performed in March 2005 (right eye) and April 2005 (left eye). This treatment stopped the progression and even caused the keratometric steepness to regress over a postoperative follow-up of 22 months, as demonstrated by preoperative and postoperative corneal topographies and maximum K-readings. During the patient's second pregnancy, the keratectasia exacerbated. To our knowledge, this is the first case showing exacerbation of keratectasia despite CCL and, as the exacerbation occurred only during pregnancy, suggesting that hormonal changes might affect corneal biomechanical stability.

Determination of the Excimer Laser Ablation Rate in Previously Cross-linked Corneas

“…Current limitations of the technique include reduced efficacy in extremely thin corneas and during pregnancy. [11][12][13] The improvement in the biomechanical state of the cornea opens up new opportunities for visual rehabilitation in irregular astigmatism: customized photorefractive keratectomy may be used to regularize the corneal surface, combining a depthlimited surface ablation with a subsequent CXL either in the same procedure or sequentially (months to years after CXL). [14][15][16][17][18][19] The photopolymerization process that occurs during CXL follows the Lambert-Beer law of photophysics, which describes the gradual light energy absorption with depth.…”

Corneal collagen crosslinking using riboflavin and ultraviolet-A light for keratoconus

“…31 In addition, surgeons must be aware of potential complications of the procedure. 32,33 Given the mounting clinical evidence, it would be preferable to treat earlier stages of progressive keratoconus in an effort to better preserve visual acuity.…”

Effects of Corneal Cross-linking on Contrast Sensitivity, Visual Acuity, and Corneal Topography in Patients With Keratoconus

“…Pregnancy is known to be one of the reasons for ectasia progression and exacerbation, probably because of hormonal variations. 29 The human cornea has estrogen receptors, and there is experimental evidence that exposure to estrogen reduces the biomechanical stability of the cornea. 30 Despite some temporary corneal haze, no severe adverse events were seen.…”