Possible Hope for Post-LASIK Ectasia

Walt Bethke, Managing Editor

http://www.revophth.com/index.asp?page=1_634.htm

One of the most disheartening, and downright scary, complications of LASIK is corneal ectasia, since it’s a condition that will get progressively worse and take the patient’s vision with it. Some surgeons, however, are trying novel techniques on patients with post-LASIK ectasia, and say the results show promise. Here’s a discussion of how these emerging methods may help these eyes.

I wonder how many of these ectasia patients, if presenting for LASIK surgery today, would still be considered good candidates.

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Originally posted by Dr. DavOD Hartzok:
I wonder how many of these ectasia patients, if presenting for LASIK surgery today, would still be considered good candidates.

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EXACTLY!!!!!!!

Read my tag line under my signature!

As the volunteer assistant to Dr. Percy Amoils for the Ectasia Support/Study Group, I have been able to view a lot of private information of the cases of the group members.

I have seen poor screening and decisions from both optometrists and ophthalmologists. My personal opinion is that the ophthalmologist bears the blame for the poor decisions regardless of the screening of the optometrist. The surgeon should make the final decision before surgery...just my opinion.

We have members in the support group with puzzling cases. Some of the cases have become better understood because the flap thickness has been measured by either the confocal or artemis which confirmed the flap was thicker than expected. We have a baffling case that perhaps would have not developed if the patient had been older when screened. Problems with naturally occurring keratoconus can develop in a patient's late 20's or early 30's. Maybe the young age of a patient having LASIK could be considered a risk factor for having LASIK.

I have a great respect for the doctors who have abandoned LASIK for safer surface ablation..... whether that procedure be LASEK or PRK.

I don't claim to be a brilliant person but I have always felt my decision to have PRK for my high myopia was based on logical thinking. To cut the flap the suction is so strong that it can cause problems to a more fragile retina in a high myope and why people aren't scared of the blade is beyond me!!!

I am involved in the ectasia support/study group totally as a volunteer because I know I escaped the horror of either blindess or ectasia by choosing PRK for my -12.00 myopia.

Gail,

It is generally presumed that ectasia is a result of too thin a residual stroma (in lieu of an underlying corneal degeneration) and that ectasia is a gradual process linked, in part, to the intraocular pressure. Have you come across any literature that suggests ectasia as an immediate outcome of the flap cutting procedure? By this I mean, could the physical application of suction mechanically induce ectasia from the outset?

"Could the physical application of suction mechanically induce ectasia from the outset?"

I have never heard of that. I have only heard of retinal problems after LASIK caused by the suction needed to cut the flap.

Unfortunately, we are seeing cases of ectasia develop that are related to problems because of the lack of accuracy of the microkeratome. This cause of ectasia can not be determined unless the flap is measured. I have 2 members who have found out their ectasia was caused by a thicker than expected flap. The artemis verified the reason for ectasia developing in both members with normal pre-op topography and a corneal thickness that was calculated to be safe for their amount of tissue removal. The Hansatome microkeratome cut a 240µm flap in both eyes of one of my members. It took 18 months post-op for the ectasia to become noticable in one eye. There is concern that her other eye will develop ectasia as time passes.

We have to look at history and feel concern for the future of some patients who have had LASIK. It took as much as 8 years for some patients to develop progressive hyperopia after the old refractive procedure RK. We are going to likely see the same pattern to some extent with some individuals who have pushed the limits with LASIK.

I do not intend to be an alarmist, but I think we have to be realistic about what might could occur. Of course, I also believe many LASIK patients will be just fine in the future just as a select group of RK patients are still doing fine.

This message has been edited. Last edited by: Gail Keziah,