Hello,

I am writing to inquire about my options for correcting my unfortunate and rare case of LASIK-induced keratoectasia in my left eye. My initial LASIK procedure was performed on July 31, 2001, followed by two enhancements, which resulted in this condition. I continued follow-up with this surgeon after he transferred to a different practice in New York City. Seeing that I was a candidate for the INTACTS procedure, he performed this surgery on my eye on 1/12/06. The surgery resulted in some corneal flattening and, in fact, the surgeon presented the results of my procedure as a case study at a conference. He has since transferred out of this practice as well. To my dismay, I am still having quite some difficulty with vision in this eye (e.g., ghosting of images, blurriness, poor scotopic vision, etc.), even after being fit for a soft toric contact lens. Being that my profession (professor, researcher) relies heavily on reading, my work productivity, not to mention my overall well-being, has been affected. Approaching desperation, I am thus searching for my remaining options at this point, aside from corneal transplant PKP. I have been reading about a promising procedure called Corneal Collagen Crosslinking with Riboflavin. Who currently offers this procedure? Anyone in the New York area?

I am hoping that you would be able to assist me with my possible alternatives.

Thank you in advance, sincerely, for your assistance.

Dr. D.

It is my understanding that corneal collagen cross-linking with riboflavin is still controversial. It seems the patient base is quite low and, for the most part, the procedure has been applied to keratoconus patients, patients whose corneal physiology is much different from that of post-LASIK patients. In spite of the differences in corneal physiology, strengthening of the residual corneal stroma would make sense in cases of keratectasia and this procedure has been performed in patients following Intacs placement. So, the case for C3-R in your situation has a precedent. (http://www.ophthalmologytimes.com/ophthalmologytimes/article/articleDetail.jsp?id=86342)(http://www.crstoday.com/PDF%20Articles/0105/f12_boxerwachler.html)

Strengthening the corneal collagen may halt ectatic progression but it may not result in optical normalcy. In other words, C3-R may not reduce or eliminate the existing distortion. It would be helpful to know if the ectasia is stable or not (serial corneal topography). If it is unstable, then it would seem reasonable to pursue this. If the corneal profile is stable, then the use of the procedure for vision improvement would seem less predictable as a benefit.

A cornea subjected to LASIK plus two enhancements, followed by Intacs and deemed ectatic is pretty far off the norm. The prognosis for additional procedures and/or contact lens success is not knowable.

Dear Dr. D

Over the years I have treated a large number of ectasia patients very successfully with scleral lenses. Soft lenses and RGP contact lenses do not work well due to the compromised corneal tissues and significant corneal distortion. Scleral lenses vault over the cornea and are supported by the white portion of the eye (the sclera). A special fluid fills the space between the back surface of the scleral lens and the front surface of the cornea. This fluid environment promotes corneal healing. Comfort and vision is usually very good to excellent. By the way, lasik-induced ectasia is not as rare as you might think.

Edward Boshnick, O.D.,F.A.A.O.
Miami, Fl
www.eyefreedom.com