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R. A. Shah, K. L. Fry, P. S. Hersh; Visual Outcomes and Topographic Features of Corneal Ectasia Following Laser Refractive Surgery. Invest. Ophthalmol. Vis. Sci. 2009;50(13):575.
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Corneal Ectasia is an important though uncommon complication of laser refractive surgery. Here we seek to report our own experience caring for these patients. In addition to reporting optical and visual parameters observed, we analyze topographic features of this condition in a series of 30 patients.
Patients who presented to the Hersh Vision Group from February 2001 to July 2008 with a diagnosis of ectasia following laser refractive surgery were identified. Data collected from the charts of these patients was compiled in a database and analyzed. In addition to standard keratometry, corneal topography was also assessed. Each eye was classified as pellucid pattern or classic keratoconus pattern ectasia based on topography. These subgroups were also used for analysis.
46 eyes diagnosed with post laser ectasia were analyzed. 16 patients had bilateral disease. Average amount of time from original refractive procedure until presentation at our office was 5.2 years. 12 eyes had undergone more than one laser refractive treatment. The mean final Uncorrected Visual Acuity (UCVA) was 20/200, and mean Best Corrected Visual Acuity was 20/40. The most common treatment was Rigid Gas Permeable (RGP) Contact Lens. Other patients were managed with Intacs and conductive keratoplasty. Recently some of these patients have been enrolled in a collagen cross-linking clinical trial. 17 eyes were classified as pellucid pattern ectasia, while 25 eyes were classified as having a classic ectasia pattern based on corneal topography. Pellucid pattern patients had a tendency towards better UCVA, but other measures were comparable.
Corneal ectasia following refractive laser surgery remains an important entity whose characterization is yet incomplete. Our report confirms recent suggestions that post-surgical ectasia can often be effectively managed with non-surgical interventions such as RGP lens. For patients with contact lens intolerance or progression of disease, more invasive interventions should be considered. There appear to be distinct topographic subtypes of post-surgical ectasia. Whether these morphologies share a common pathophysiology is uncertain.
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