EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1344259
MARCH 2021 | EYEWORLD | 77 R patients he would not recommend for surgery today. "In one case, the preoperative topography had a huge difference. It was a 3 D inferior vs. superior difference on the map. … The map that was sent to me was printed in 1 D steps. It mat- ters because when you do big steps, everything smooths out," he said, explaining the impor- tance of using a scale with a high enough granularity to detect abnormalities. Dr. Schoenberg said the long-term safety data on refractive surgery offers confidence to patients, as well as the fact that there are treatments should the rare complication of ectasia arise postop. "I don't minimize its risk but I do instill confidence about what we're looking at before surgery and what we can do after surgery because if we have this condition that is unstoppable and scary, that's very different from a condition that can be controlled and managed," he said, explaining that crosslinking can effectively stop ectasia before it poses a significant problem. As a cornea and refractive keratoconus spe- cialist, Dr. Schoenberg gets a referral for ectasia after refractive surgery every couple of weeks, but he said most of these cases are 10-plus years postop. He said when he has the opportunity to review the preop testing on these patients with a current knowledge base, sometimes they are References 1. Seiler T, Quurke AW. Iatrogenic keratectasia after LASIK in a case of forme fruste kerato- conus. J Cataract Refract Surg. 1998;24:1007–1009. 2. Randleman JB, et al. Risk factors and prognosis for corneal ectasia after LASIK. Ophthalmol- ogy. 2003;110:267–275. 3. Rad AS, et al. Progressive keratectasia after laser in situ keratomileusis. J Refract Surg. 2004;20:S718–S722. 4. Pallikaris IG, et al. Corneal ectasia induced by laser in situ keratomileusis. J Cataract Refract Surg. 2001;27:1796–1802. 5. Bohac M, et al. Incidence and clinical characteristics of post LASIK ectasia: A review of over 30,000 LASIK cases. Semin Oph- thalmol. 2018;33:869–877. 6. Randleman JB, et al. Validation of the Ectasia Risk Score System for preoperative laser in situ keratomileusis screening. Am J Ophthalmol. 2008;145:813–818. 7. Santhiago MR, et al. Asso- ciation between the percent tissue altered and post-laser in situ keratomileusis ectasia in eyes with normal preoperative topography. Am J Ophthalmol. 2014;158:87–95. Common appearance of ectasia: Tomographies from each eye of a 39-year-old who had myopic LASIK in 2009 with progressive vision loss over the past 4 years Source: Evan Schoenberg, MD