LASIK Complications? A New Hope for Ectasia Treatment
"Allogenic lenticule addition combined with corneal cross-linking shows promising results in treating post-LASIK ectasia with corneal thinning."
Post-LASIK ectasia, a potential complication following LASIK surgery, leads to progressive corneal thinning and bulging, resembling keratoconus. This condition can significantly impair vision, initially managed with glasses or contact lenses. However, as ectasia advances, surgical intervention becomes necessary when these options are no longer sufficient.
Corneal cross-linking (CXL) has emerged as a well-established method for halting the progression of keratoconus. Recent advancements in laser technology have led to the development of small incision lenticule extraction (SMILE), offering new possibilities for treating various corneal conditions. One such approach involves using stromal lenticules extracted during SMILE procedures to address hyperopia, corneal perforations, keratoconus, and even post-LASIK ectasia.
A recent case study investigates the long-term outcomes of combining lenticule addition with corneal cross-linking for treating post-LASIK ectasia accompanied by corneal thinning, providing valuable insights into this innovative technique.
The Innovative Technique: Lenticule Addition and Corneal Cross-Linking
The case report details the experience of a 26-year-old male who developed bilateral post-LASIK keratectasia two years after undergoing LASIK in 2009. By April 2015, the patient sought treatment for his left eye at the clinic, as he could not tolerate rigid gas permeable contact lenses. The patient's left eye underwent lenticule addition followed by corneal cross-linking.
- Medication Regimen: Post-operative care included levofloxacin four times daily for 3 days, fluorometholone 0.1% eight times daily, gradually reduced over 24 days, and tear supplements four times daily for one month.
- CXL Procedure: Four months after lenticule addition, when corneal thickness was adequate (412 µm), CXL was performed using ParaCel and VibeX Xtra solutions, followed by ultraviolet treatment using the KXL System.
- Post-CXL Care: This included antibiotic drops for one week and fluorometholone 0.1% for 16 days, tapered gradually, plus tear supplements four times daily for one month.
A Promising Path Forward
This case presents a compelling treatment avenue for individuals grappling with keratectasia and keratoconus, especially those with thin corneal thicknesses (below 400 µm). By potentially delaying or averting the necessity for keratoplasty, this approach circumvents the associated complications and donor cornea limitations.
Lenticule addition combined with CXL demonstrates efficacy, safety, and stability, marking it as a promising surgical technique for post-LASIK ectasia. While this case involved a lenticule from a myopic patient, future studies incorporating hyperopic lenticules could further validate the long-term advantages of this surgical strategy for post-LASIK ectasia with thin corneas.
Ultimately, employing lenticule addition before CXL in post-LASIK ectasia patients experiencing progressive corneal thinning and bulging emerges as an effective strategy, carrying reduced risk and a shorter treatment duration compared to traditional lamellar keratoplasty, heralding a new era of hope for those seeking vision correction after LASIK complications.