Corneal ectasia following photorefractive keratectomy: a confocal microscopic case report and literature review

Alvani, Azam; Hashemi, Hassan; Pakravan, Mohammad; Aghamirsalim, Mohammad Reza

doi:10.5935/0004-2749.2021-0296

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CASE REPORT • Arq. Bras. Oftalmol. 87 (6) • 2024 • https://doi.org/10.5935/0004-2749.2021-0296 copy

Corneal ectasia following photorefractive keratectomy: a confocal microscopic case report and literature review

Ectasia corneana após ceratectomia fotorrefrativa: relato de caso de microscopia confocal e revisão da literatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The occurrence of corneal ectasia after photorefractive keratectomy is a rare but serious complication of refractive surgery. Possible risk factors are not well assessed, but a probable reason is the failure to detect keratoconus preoperatively. In this report, we describe a case of corneal ectasia after photorefractive keratectomy in a patient who presented a suspicious tomography pattern preoperatively but had no degenerative alterations associated with pathologic keratoconus, as revealed by in vivo corneal confocal microscopy. We also review eligible case reports of post-photorefractive keratectomy ectasia to find similar characteristics.

Keywords:
Cornea/pathology; Dilatation, pathologic; Keratoconus; Photorefractive keratectomy; Keratomileusis, laser in situ; Microscopy, confocal; Humans; Case reports

Authors		Patient’s sex, age, affected eye, CDVA, CCT, and ectasia detection time	Refraction (Diopter)	Keratometry (Diopter)	Topography	Other findings
Malecaze et al (²2 Malecaze F, Coullet J, Calvas P, Fournie P, Arne JL, Brodaty C. Corneal ectasia after photorefractive keratectomy for low myopia. Ophthalmology. 2006;113(5):742-6.) (2005)		Male, 22 y, OU, OU: 20/20, OU: 495 μm, 4 y later	OD: -1.50 -1.00 × 105 OS: -1.50 -1.00 × 65	OD: 43.75/43.32 OS: 43.88/43.26	OD: moderate temporal steepening, SRAX = 37, KISA% = 12.3 OS: inferior steepening, J shape, SRAX = 60, I-S value = 0.9, KISA% = 20 Final diagnosis: FFKC (OS)	Normal slit-lamp biomicroscopy findings, negative familial history
Chiou et al (³3 Chiou AG, Bovet J, de Courten C. Management of corneal ectasia and cataract following photorefractive keratectomy. J Cataract Refract Surg. 2006;32(4):679-80.) (2006)		Male, 40 y, OU, OU: 20/25, OD: 477 μm / OS: 481 μm, 18 months later	OD: -9.25 -1.25 × 65 OS: -8.25 -2.00 × 160	-	Normal	Post-PRK severe corneal haze and long-term steroid use, severe corneal tissue ablation
Randleman et al (⁴4 Randleman JB, Caster AI, Banning CS, Stulting RD. Corneal ectasia after photorefractive keratectomy. J Cataract Refract Surg. 2006;32(8):1395-8. Comment in: J Cataract Refract Surg. 2007;33(6):941-2; author reply 942.) (2006)	Case 1	Male, 37 y, OU, OD: 20/20/ OS: 20/30, OD: 472 μm / OS: 441 μm, 2 weeks later	OD: -1.50 -2.50 × 70 OS: -4.00 -3.00 × 90	OD: 45.50/46.50 OS: 48.50/50.20	KC in both eyes	-
	Case 2	Male, 40 y, OU, OD: 20/20^-2/ OS: 20/20^-1, OD: 509 μm / OS: 508 μm, 10 months later	OD: -5.75 -3.75 × 33 OS: -5.25 -4.00 × 167	OD: 46.68/43.21 OS: 46.80/43.38	Symmetric bowtie, high oblique astigmatism	Normal slit-lamp biomicroscopy findings, positive familial history, postoperative IOP rising, and eye rubbing
Leccisotti (⁵5 Leccisotti A. Corneal ectasia after photorefractive keratectomy. Graefes Arch Clin Exp Ophthalmol. 2007;245(6):869-75.) (2007)	Case 1	Female, 38 y, OU, -, OD: 520 μm / OS: 510 μm, 3 y later	OD: -7.00 -3.00 × 180 OS: -6.00 -4.00 × 180	OD: 44.30 OS: 45.50	High astigmatism and inferior steepening (1.3 and 1.6 D) in both eyes Final diagnosis: KC in both eyes	-
	Case 2	Male, 31 y, OD, 20/20, 487 μm, 1 y later	OD: -4.50 -1.75 × 175	OD: 45.75	KC in the fellow eye (OS)	-
	Case 3	Male, 31 y, OS, 20/20, OD: 506 μm / OS: 492 μm, 5 months later	OS: -3.75 -0.50 × 150	OS: 45.70	Evident inferior steepening, asymmetric bowtie with SRAX in both eyes, abnormal ABR index in OS. Videokeratography ruled out KC in both eyes. Final diagnosis: KC suspect (OS)	No information about familial history of KC, slit-lamp biomicroscopy findings, or retinoscopy
	Case 4	Female, 38 y, OS, 20/20, 509 μm, 5 months later	OS: -1.50 -1.25 × 130	OS: 48.30	Evident inferior steepening especially in OS, abnormal vertical asymmetry index, and Kmax = 48.30 in OS. Videokeratography ruled out KC in OD and defined possible in OS. Final diagnosis: KC suspect (OS)	No information about familial history of KC, slit-lamp biomicroscopy findings, or retinoscopy
Navas et al (⁶6 Navas A, Ariza E, Haber A, Fermón S, Velazquez R, Suarez R. Bilateral keratectasia after photorefractive keratectomy. J Refract Surg. 2007;23(9):941-3.) (2007)		Male, 35 y, OU, OU: 20/20, OD: 497 μm / OS: 511 μm, 2 weeks later	OD: -3.00 -1.50 × 20 OS: -3.00 -2.00 × 160	OD: 43.25/45.00 OS: 43.25/45.50	Asymmetric astigmatism and FFKC in both eyes which was more pronounced in OD	Normal slit-lamp biomicroscopy findings, positive familial history, eye rubbing
Reznik et al (⁷7 Reznik J, Salz JJ, Klimava A. Development of unilateral corneal ectasia after PRK with ipsilateral preoperative forme fruste keratoconus. J Refract Surg. 2008;24(8):843-7.) (2008)		Male, 25 y, OD, OU: 20/25, OD: 500 μm / OS: 460 μm, 5 y later	OD: -5.75 -1.75 × 95 OS: -7.50 -1.25 × 80	OD: 42.50/42.25 OS: 43.25/44.00	KC (OD)	-
Bardocci et al (⁸8 Bardocci A, Abad JC, Tamburrelli C, Lofoco G, Benevento M, Lischetti A. Early onset keratectasia after photorefractive keratectomy in a case showing Vertical D topographic pattern. Semin Ophthalmol. 2012;27(3-4):52-5.) (2012)		Female, 31 y, OU, -, OD: 512 μm / OS: 520 μm, 6 y later	OD: -8.00 -2.00 × 30 OS: -4.50 -1.50 × 150	-	AB/SRAX in OD, D pattern in OS Final diagnosis: KC suspect (OU)	No information about familial history of KC, personal history of allergy or eye rubbing, slit-lamp biomicroscopy findings, or retinoscopy

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[1] Corresponding author: Hassan Hashemi, MD. Email: research@norc.ac.ir