LASIK Ectasia

 

Corneal Ectasia After LASIK

Intraocular pressure inside the eye pushes constantly against the back surface of the cornea. In a healthy eye, the collagen bands of the cornea provide support to withstand these forces. LASIK surgery involves cutting a corneal flap, which severs collagen bands that never reconnect. After creation of the flap, the surgeon uses a laser to remove corneal tissue, further thinning the cornea. Together, flap creation and laser ablation reduce stress-bearing thickness of the cornea, leaving the cornea permanently weakened.

Post-LASIK keratectasia (ectasia) is a sight-threatening complication of LASIK in which the weakened cornea begins to bulge forward in response to the pressure inside the eye. When this occurs, vision deteriorates progressively. Ectasia usually occurs within weeks or months of LASIK, but may occur several years after seemingly uneventful LASIK. (1)

Reported risk factors for post-LASIK corneal ectasia include abnormal corneal topography, low residual stromal bed thickness, young patient age, low preoperative corneal thickness, and high myopia. (2) The FDA website warns, “Performing a refractive procedure on a cornea that is too thin may result in blinding complications.” (3)

Treatment modalities for post-LASIK ectasia include rigid gas permeable contact lenses (RGPs) and corneal transplantation. Clinical trials of corneal collagen cross-linking with riboflavin/UVA light to treat corneal ectasia are underway.

The true rate of post-LASIK ectasia is unknown. Due to the fear of ectasia, some surgeons have stopped performing LASIK.

Media

  • Ectasia
    Click to Enlarge

This photo shows the eye of a patient who had botched RK surgery followed by a corneal transplant. The transplanted cornea developed ectasia.

FDA Submitted reports related to LASIK induced Ectasia

Many of these reports show a pattern of depression, shock, PTSD and serious physical as well as emotional harm as a direct result of the LASIK procedure.

  • I Have Post-Lasik Ectasia And My Insurance Company Will Not Cover The Procedure Recommended Intacs, Keratoplasty, And Uv Collagen Treatment By My Doctor, Dr. (B)(6). Numerous Visits To Ophthalmologist, Had To Spend About (B)(6) On Procedure So Far. Uv Collagen Crosslinking.

     

    Reported: 04-Jan-13

  • Had Lasik Performed On Both Eyes In 2001. Recently, Vision Has Deteriorated In Right Eye. Not Knowing That The Problem Was, Investigated Having Another Lasik Procedure And Was Told That I Have A “Coning” Of The Cornea. Described To Me As Keratoconus,

     

    Reported: 31-Aug-12

  • A Center Director Reported, Via Medwatch Form 3500, One Right Eye Case Of Ectasia Associated With Decrease In Vision, Diagnosed Nine Years Post Lasik Surgery. The Surgeon Was Reported To Be Consulting With Partnering Physician On Possible Treatment Options, Including Topography Guided Excimer Laser With Crosslinking. Pt Underwent Lasik For Both Eyes (Ou) On (B)(6) 2003. On (B)(6) 2003, (B)(6) Days Post Op, Exam Noted Trace Roughness Right Eye (Od) Greater Than Left Eye (Os). Pt Instructed To Use Clioxan One Drop 4 Times A Day For 7 Days Ou. Econopred One Drop Every Hour Od And 4 Times A Day Os. Artificial Tears 4 Times A Day Od. On (B)(6) 2003, (B)(6) Days Post Op Exam Noted 1+ Spk Od And Trace Spk Os. Pt Was Instructed To Return To The Clinic For Punctal Plugs For 3 Months. On (B)(6) 2003, (B)(6) Days Post Op, Exam Noted Punctal Plugs Placed Ou. On (B)(6) 2004, 1 Year Post Op, Exam Noted Trace Spk Ou. The Pt Was Released From Care. On (B)(6) 2012, 9 Years Post Op, The Pt Stated Decrease In Vision Od Past 2-3 Years.

     

    Reported: 08-Jun-12

  • Had Lasik Done In 2000. In 2012, Diagnosed With Corneal Keratoconus Ectasia. Which Now I Will Now Be Fitted For A Hard Lens That Might Stabilize The Problem. But Eventually Will Lead To A Corneal Transplant. (B)(6).

     

    Reported: 15-Mar-12

  • Center Director Reports, Via A (B)(4), A Case Of Postoperative Keratoconus Or Ectasia, After Lasik Surgery. Post Operative Findings Show Patient Experienced Irregular Astigmatism, And Loss Of Bcva. Patient Also Reported Blurry Vision For The Past Two Years. This Report References The PtS Left Eye. Right Eye Is Reported Under Mfr Report # 1061857-2011-00011. AddL Info From Uf Report: Possible Keratoconus Or Ectasia.

     

    Reported: 11-Nov-11

References

  1. Lifshitz T, Levy J, Klemperer I, Levinger S. Late bilateral keratectasia after LASIK in a low myopic patient. J Refract Surg. 2005 Sep-Oct;21(5): 494-6.
  2. Randleman JB, Woodward M, Lynn MJ, Stulting RD. Risk assessment for ectasia after corneal refractive surgery. Ophthalmology 2008;115:37–50
  3. FDA warning
Special thanks to Dr Edward Boshick for the supplied media. Eye Freedom