Lasik followed by Ectasia and Intacs and Ferrara Rings

This is a photo of my patient Ana and me. Ana first visited our office from Mexico 2 years ago. In 2000, Ana underwent LASIK surgery in both eyes. When her vision began to fail, Ana underwent a 2nd LASIK procedure in each eye in 2003. Shortly after undergoing her 2nd LASIK procedure, Ana developed ectasia in her left eye. In an attempt to smooth out the surface of the left cornea, Ana’s surgeon attempted to insert Intacs (corneal rings) into her cornea. During the Intacs surgery, the cornea got damaged forcing Ana to have an emergency corneal transplant in her left eye. About 8 years later, ectasia developed in Ana’s right cornea. Corneal ectasia is a condition that can develop years after refractive surgery such as LASIK is done. It is characterized by a thinning and protrusion of the corneal surface. A corneal surgeon in Mexico suggested that Ferrara Rings be inserted into her right cornea to reduce or eliminate her ectasia. Ferrara Rings are very similar to Intacs except that they do not have FDA approval for use in the US. In addition, the separation of the Ferrara Rings within the cornea is much closer than seen with Intacs and can interfere with night vision. Look carefully at the first ocular photo. This shows Ana’s right cornea with the Ferrara Rings. Note that these rings are along the pupillary border and are affecting Ana’s night vision. The 2nd ocular photo shows Ana’s left corneal transplant. The white- gray ring circling the peripheral cornea is the junction between the host and donor cornea. Look carefully and you can see new blood vessel growth onto the donor cornea at 12:00 and at 1:00. Rarely do these blood vessels traverse the host-donor interface. This condition (neovascularization) will have to be monitored for an indefinite period of time. Before visiting our office 2 years ago, Ana was not able to tolerate any type of contact lens. In addition, eyeglasses did not allow her to have functional vision. For the past 2 years Ana has been wearing GVR Scleral lenses which are allowing her to see clearly (20/25 in each eye) and comfortably once again.

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