Lasik Ectasia Articles

Lasik a Decade Ago, then Ectasia and Intacs

This is a photo of the lower portion of the left cornea of an eye that underwent LASIK surgery 10 years ago and developed a corneal ectasia several years later. In an effort to undo the damage to the cornea created by LASIK, Intacs (plastic intra corneal rings) were surgically implanted into this cornea. Several years after the Intacs surgery this eye became infected and inflamed from this plastic rings. The lower ring was surgically removed several years ago. In this photo note the curved gray scar. This is due to the surgery to remove the Intacs. Also note the numerous small blood vessels around this scarred area. Understand that the cornea is normally devoid of blood vessels. This patient is now wearing a scleral lens on this eye which is providing him with clear (20/20) vision for the first time in many years. For the past few years this cornea has remained stable and the vision in this eye has remained clear.

Simulation of vision with post-Lasik Ectasia

The image below is a computer enhanced image demonstrating how one of my patients with post-LASIK corneal ectasia sees the world. As you can see from this image, the patient may be able to identify the 20/20 line on the acuity chart. However, there is a significant difference between quality vision and quantity vision. Many patients with "higher order aberrations" like this patient were told by their LASIK doctors that they should not complain since they are identifying the small letters on the acuity chart. Properly fit scleral lenses have the ability to correct this type of vision. For this reason, members of this forum suffering from this type of vision should not give up hope.

Lasik 12 years ago, Ectasia a few years later

This is a photo of an eye that underwent LASIK surgery about 12 years ago and developed post LASIK corneal ectasia several years later. In an attempt to make this patient's cornea less irregular a procedure known as Conductive Keratoplasty (CK) was done. CK involves the use of a small probe that uses radio wave to reshape the cornea. Before taking this photo, we instilled a special dye onto the ocular surface and placed a special filter before the microscope in order to highlight the defects on the cornea. The bright ring going around the corneal periphery is the LASIK flap. The fact that you see the dye lets you know that there is space between the LASIK border and the surrounding tissue. The green-yellow dots that are positioned like the numbers on a clock are from the CK probe. Several years after this photo was taken, this cornea began to come apart. The cornea became extremely cloudy and the corneal epithelium began separating from the underlying corneal tissue. In addition, this eye developed an internal ocular infection known as an endophthalmitis. After the infection was treated, corneal transplant surgery was done. The end result of all these surgeries was an eye with light perception only.

Lasik Ectasia 3 years after Lasik

The image shown below was taken with a computerized corneal topographer. The upper colored images show the corneal topographies of a 30 year old patient with post-LASIK corneal ectasia. This condition took place 3 years after the LASIK surgery was done. The red areas shown below represent the parts of the cornea that are protruding or "bulging" forward. This patient's unaided visual acuity is less than 20/1000 in each eye. His eyeglass correction is now in excess of -20.00 in each eye. Look carefully at the lower images and not that his pupil diameter is 8.6 mm (in dim lighting). The LASIK created treatment zones are 6.5 mm or less, making it impossible to correct his visual error. This patient, by the way, underwent LASIK when he was 17 years old. He is now wearing scleral lenses which are allowing him to see 20/25 with each eye without any distortions.

Intacs will not Restore Corneal Integrity

In my opinion, patients suffering from post-LASIK corneal ectasia should avoid undergoing Intacs surgery. This technology will not restore integrity to the distorted corneal surface. In this photo, note the inflammation and blood vessel growth over and around the Intacs ring. This patient almost had to have a corneal transplant done during the surgical removal of the lower Intacs ring. Over the years, I have had a number of patients who had these plastic rings surgically removed due to ocular pain and added vision distortion.

Ectasia - Do NOT get Intacs

To the members of this group who were diagnosed with post-LASIK ectasia and were told that Intacs surgery was indicated to correct this condition, please consider the photos below. All of these photos were taken of the same eye at different times. This eye underwent LASIK about 15 years ago. Several years later this patient was told that he had ectasia in this eye and that the best way to correct this condition was Intacs surgery. Intacs are plastic rings that are surgically inserted into the center of the cornea. The idea of these rings is to make the cornea more spherical. Several years after these rings were inserted into this cornea, crystals began forming over and around the Intacs rings. 5 years later, an inflammatory response developed around the lower plastic ring with significant blood vessel growth. One year later the lower Intacs ring was surgically removed. The corneal surgeon who removed this Intacs ring told me that it was touch and go as far as the need for a corneal transplant was concerned. The last photo shows this cornea after the Intacs was removed. This cornea will be permanently scarred. The point that I am trying to make is to be careful about any additional surgeries suggested to you to undo the damage caused by the first surgery. By the way, this patient is currently wearing a scleral lens over this eye for vision and comfort purposes.

Ectasia with Scarring

For those members who have developed post-LASIK corneal ectasia and are thinking about undergoing laser surgery to smooth out the corneal surface, please take the photos below into consideration. In the first photo, notice the cloudy areas in the center of the photos. This is scarring created by the laser. Look carefully at the "smiley face" white line at the bottom of the photo. This is the outline of the LASIK flap. The laser procedure degraded the vision in this eye and the scarring is permanent. The 2nd photo also shows a post-LASIK cornea with ectasia. This eye underwent Intacs surgery after the diagnosis of ectasia was made. The thick translucent structure going around the lower half of this photo is the Intacs ring. The Intacs did nothing to undo the corneal irregularity created by the LASIK surgery. Note the grey haze just above the Intacs. This is the scarring created by the laser surgery that was done in an attempt to make this cornea more spherical. Neither the Intacs or the laser procedure improved the vision in this eye. In fact, the corneal distortion and vision was made worse by these 2 additional surgeries.

Scleral Lens over Lasik Ectasia with Intacs

This is a profile view of a scleral lens on an eye with post-LASIK corneal ectasia. Look carefully and you can see the Intacs plastic ring in the lower half of the cornea. This cornea is extremely profound and the Intacs did very little to address this condition. In fact, the Intacs made fitting the scleral lens more difficult. Eyeglasses and conventional contact lenses were not able to provide this patient functional vision with this eye. With the scleral lens this patient can see clearly (20/25) and comfortably with all day vision.

Lasik in 2000 followed by Ectasia and Hydrops

The photos below are of the same eye taken 4 years apart. This eye underwent LASIK surgery in 2000. About 5 years later this eye developed post-LASIK corneal ectasia. In the lower left profile photo notice the protrusion or "bulging" of the cornea. This photo was taken about 6 years ago. The lower right photo is of the same eye taken 2 years ago. On this eye you can see a scleral lens. The cloudy area just below the pupil is due to a condition known as "hydrops". This condition is due to the most posterior corneal membrane (Descemets membrane) rupturing. When the intra ocular pressure against the weakened cornea is too great for the post-LASIK cornea to endure, this membrane will rupture allowing fluid from within the eye (the aqueous) to enter the center of the cornea. While there is no pain associated with this condition, vision can be severely compromised. The scleral lens is the only non-invasive technology that will allow this eye to provide functional vision. If the central area of the cornea becomes clouded obscuring vision, corneal transplant surgery will be the only option that will allow the eye to see clearly once again.

Lasik Ectasia now 20/20 for 7 Years with GVR Scleral Lens

This is a photo of me standing next to our post-LASIK patient Jorge on my left. On the extreme left is our student extern Amanda Golchin and on the right our student extern Jenna Adelsberger. About 13 years ago, Jorge underwent LASIK surgery in both eyes. 3 years later both of Jorge's corneas became extremely distorted which was diagnosed as post-LASIK corneal ectasia. It was suggested to Jorge that the best way to correct the distorted corneas was to have Intacs surgery. Intact are plastic rings that are inserted into the center of the cornea and are intended to remove or eliminate the corneal distortion. Jorge elected to have this done in his left eye only. Over the ensuing years Jorge was fit with a variety of eyeglasses and contact lenses none of which provided Jorge with functional vision. Jorge first visited our office about 7 years ago. It was at this visit that we fit Jorge with GVR Scleral lenses. With the scleral lenses Jorge was able to achieve clear (20/20) comfortable vision for the first time in many years. It was also at this visit that I noticed crystal formation around the inferior Intacs plastic ring. Because this eye was quiet and Jorge has no issues with comfort with this eye we decided to just watch and monitor Jorge's eyes and vision. The first ocular photo shows Jorge's left eye with the Intacs taken 7 years ago. Look carefully and you can see the crystal formation in this photo. About 3 years ago, the inferior portion of Jorge's left cornea became inflamed with blood vessel growth over and around the lower Intacs ring. The 2nd ocular photo shows the inflammation in this eye. It was at this time that surgery was done to remove the lower Intacs ring in this eye. For the past 3 years, Jorge has continued to wear his scleral lenses with excellent vision (20/20 in each eye) and all day comfortable lens wear.

Lasik Followed by Ectasia. Patient now 20/20 with GVR Scleral Lens

This is a photo of me and my patient Edith. In 2002, Edith underwent LASIK surgery in both eyes. One week later she began losing vision in her left eye. About 5 months later the vision in her right eye began to fail. About one year after undergoing LASIK surgery, a diagnosis of post-LASIK corneal ectasia was made. Edith visited 6 different major eye institutions and a number of doctors before coming to our office. During this period, Edith was fit with a variety of soft, gas permeable and hybrid lenses, all without success. In 2007, Edith visited our office for a comprehensive examination and scleral lens fitting. Before visiting our office, Edith was told that the only way for her to see clearly once again was with additional surgeries and possibly corneal transplant surgery. We fit Edith with GVR Scleral lenses which have allowed her to see clearly (20/20 vision) and comfortably once again. Over the past 9 years I have seen Edith on a number of occasions. Over these years, Edith's corneas and eyes have remained stable and she has been able to wear her lenses comfortably for all of her waking hours. Edith will never need to undergo any invasive procedures such as another LASIK surgery or corneal transplant surgery.

Lasik 2002, Failing Vision in 2008, Retreatment Followed by Ectasia, now 20/20 and 20/25 with GVR Scleral Lens

This is a photo of me with my patient Ahmed, who recently visited our practice from Doha, Qatar. In 2002, Ahmed underwent LASIK surgery in both eyes. In 2008 the vision in Ahmed's left eye began to fail. Ahmed's corneal surgeon suggested that he undergo another LASIK procedure or an "enhancement" to restore the vision in his left eye. 48 hours after having the 2nd LASIK procedure, the vision in Ahmed's left eye worsened. When he returned to his surgeon, Ahmed was told that he developed keratoconus. Years later, another corneal surgeon made the diagnosis of post-LASIK corneal ectasia. Over the following years, Ahmed tried to wear a variety of contact lenses all unsuccessfully. In 2015, Ahmed was fit with hybrid lenses which provided him with quality vision but were very uncomfortable after just 2 hours of wear. Prior to having undergone LASIK surgery, Ahmed's corrected vision was 20/20 in each eye. When Ahmed first came into our office his corrected vision was 20/30 with his right eye and 20/70 with his left eye (with distortions). Another doctor back home told Ahmed that the reason he could not see well with his left eye was due to "lazy eye". Last week we fit Ahmed with GVR Scleral lenses which are providing Ahmed with clear (20/20 with his right eye and 20/25 with his left eye), comfortable vision (without distortions). While we are still making a few minor adjustments to Ahmed's lenses, I expect Ahmed to be able to wear his scleral lenses comfortably for many years to come. Ahmed will never need to undergo any additional invasive procedures to improve his vision.

Article Published: Scleral lenses in the treatment of post-LASIK ectasia

Complete Title: Scleral lenses in the treatment of post-LASIK ectasia and superficial neovascularization of intrastromal corneal ring segments.

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Scleral Lenses in the Treatment of Post-LASIK Ectasia and Superficial Neovascularization of Intrastromal Corneal Ring Segments

Objective: This case report aims to explore the use of scleral lenses for the treatment of ocular and visual complications in an adult patient presenting with post-LASIK (Laser-Assisted in situ Keratomileusis) ectasia in both eyes with cross-linking in the right eye and Intrastromal Corneal Ring Segments (ICRS; IN- tacs, Addition Technology, Fremont, California) in the left eye.

Methods: Following a comprehensive eye exam and specific testing for contact lens fitting, scleral lenses were fitted with success in both eyes and dispensed. Due to progressive fibrosis and neovascularization of the inferior ICRS in the left eye, the inferior ICRS was removed and scleral lenses were refit with success.

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Blurred Vision, Burning Eyes: This Is a Lasik Success?

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