Corneal ectasia is a group of conditions in which the cornea becomes progressively thin and begins to bulge forward, leading to worsening vision. The most common form is keratoconus, which develops naturally. In rare cases, ectasia can occur after vision correction procedures such as LASIK or PRK. This condition can cause increasing nearsightedness and irregular astigmatism over time.
Corneal ectasia refers to a group of corneal conditions, the most common being Keratoconus, but it is also an unfortunate risk of refractive surgeries like LASIK eye surgery or PRK. Excessive tissue removal is one risk factor, but ectasia is multifactorial and also relates to pre-existing susceptibility, tomography, corneal thickness, residual stromal bed, age, and other biomechanical factors.
The most common corneal condition where we see ectasia is keratoconus. Keratoconus is a non‑inflammatory, progressive corneal ectasia where the corneal collagen fibers weaken which then causes the cornea to lose its normal shape, and it begins to take on a cone‑like, bulging form.
Contact lens warpage can temporarily change corneal shape and mimic irregular astigmatism; that is not the same as structural progressive ectasia.
Corneal ectasia is a progressive condition which tends to manifest during puberty and continue to worsen as the patient eases into their 30s and 40s. The most common sign of corneal bulging is detected by a change in the patient’s refraction. Other signs and symptoms may occur but are not limited to:
Milan Eye Center provides various treatment options for patients with corneal ectasia, including corneal cross‑linking, and corneal transplants.
The primary purpose of corneal cross-linking is to halt or slow progression and stabilize the cornea; visual or refractive improvement is variable and is not guaranteed reversal. CXL is ideal for patients over the age of 14 and for early to moderate signs and symptoms of corneal ectasia. Corneal cross‑linking is performed in an office setting and takes approximately two hours total for prep time, treatment time, and proper recovery time. The most wonderful thing about this procedure is that it is minimally invasive and involves only eye drops, UV light, and a painless brushing off of the surface cells of the cornea.
For moderate to severe cases of corneal ectasia, a corneal transplant may be needed. A DALK corneal transplant, or deep anterior lamellar keratoplasty, is a surgical technique in which most of the cornea is replaced while preserving the thin posterior membrane of the eye known as the Descemet membrane and endothelium. It is an alternative to full thickness Penetrating Keratoplasty (PKP) and is indicated for the management of advanced keratoconus, corneal scarring, post‑LASIK ectasia, and endothelium sparing corneal dystrophies and degenerations.
The advantages of DALK include reduced rejection rate, reduced risk of late endothelial cell failure, quicker stabilization of the wound and earlier return to unrestricted physical activity. A shorter course of topical steroids (anti‑rejection drops) after DALK means faster healing and less risk for steroid‑induced glaucoma and cataracts.
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