Corneal ectasia after LASIK despite low preoperative risk: Tomographic and biomechanical findings in the unoperated, stable, fellow eye

Renato Ambrósio, Daniel G. Dawson, Marcella Salomão, Frederico P. Guerra, Ana Laura C. Caiado, Michael W. Belin

Research output: Contribution to journalArticle

72 Scopus citations

Abstract

PURPOSE: To report a case of progressive corneal ectasia after LASIK with no detectable preoperative risk factors and to present three-dimensional corneal tomographic and biomechanical findings on the contralateral unoperated eye that would be considered low risk for ectasia and thereby a good LASIK candidate based on the Randleman Ectasia Risk Score System (ERSS). METHODS: A case report, literature review, and description of novel screening criteria based on Pentacam (Oculus Optikgeräte GmbH) corneal tomography are presented as well as Ocular Response Analyzer (ORA, Reichert Instruments) corneal biomechanical analysis. RESULTS: Progressive corneal ectasia after LASIK of the operated left eye was confirmed by corneal topography. Scheimpflug imaging identified a meniscus-shaped LASIK flap with a central thickness of 165 μm and residual stromal bed thickness of 280 μm. Randleman ERSS score was 2 for the ectatic eye before LASIK and 1 for the current status of the unoperated eye, which remained stable with normal topography and no change in refraction for >5 years. Low corneal hysteresis (8.6 mmHg) and corneal resistance factor (7.5 mmHg) were found in the unoperated, nonectatic eye, along with a suspicious waveform sign of a second rebounded peak after second applanation. Pentacam average pachymetric progression was 1.09 (normal is <1.15); the Belin-Ambrósio overall deviation index was 1.99 (normal is <1.9). CONCLUSIONS: Three-dimensional corneal tomographic and ORA biomechanical measurements provide additional information that may help identify individuals at high risk for naturally occurring or iatrogenic corneal ectasia.

Original languageEnglish (US)
Pages (from-to)906-911
Number of pages6
JournalJournal of Refractive Surgery
Volume26
Issue number11
DOIs
StatePublished - Nov 1 2010

ASJC Scopus subject areas

  • Surgery
  • Ophthalmology

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