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Post LaserVisionCorrection Ectasia

 

Literature review has pointed out the most common risk factors for post-LASIK ectasia:
Preoperative corneal topographic abnormalities
Residual stromal bed thickness bellow 300 µm
High myopia and myopic astigmatism
Patient age (below 25 years old)
Preoperative corneal thickness (less than 500 µm)
Unpublished observations collected from our personal files (9800 patients) include some additional potential risk factors:
Familiar history of keratoconus
Increased amount of higher-order aberrations
BCVA less than 20/25
Topographic and refractive instability

  • High myopia

  • Residual stromal bed < 250

  • Preoperative pachymetry < 500

  • Steep keratometry (47-50 D)

  • Abnormal topography

    a. Inferior steepening
    b. Irregular astigmatism
    c. Asymmetric astigmatism
    d. Abnormal posterior float

  • Enhancements

  • Younger age

Treatments

  1. Reduce IOP

  2. Riboflavin crosslinking

  3. Intracorneal ring

  4. Keratoplasty

 

E. Prevention

  1. Avoid LASIK in "borderline" cases

  2. Surface ablation procedures

  3. Intraoperative pachymetry

  4. Second opinion for patients that are not ideal candidates

 

 

 

 

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