What is Corneal Ectasia?

Corneal ectasia, also marked by progressive corneal bulging and thinning, is a rare but serious complication resulting from vision correction procedures such as laser-assisted in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) and is associated with worsening vision.

What Causes Corneal Ectasia?

Corneal Ectasia refers to a group of corneal conditions, most common being keratoconus, but it is also an unfortunate risk of refractive surgery like LASIK or PRK. Post-LASIK/PRK ectasia is characterized by removing too much corneal tissue during the procedure which then creates irregular astigmatism. This happens when the cornea is too thin which causes the tissue to weaken and bulge under normal eye pressure.

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.

Another cause of corneal ectasia is contact lenses. Both rigid and soft lenses can alter the cornea’s shape which is why it is important to be fitted for contact lenses by a trained, board-certified professional since ill-fitting lenses can mold the cornea and mimic the signs of irregular astigmatism. The condition caused by ill-fitting contact lenses can usually be corrected with discontinued wear, as the cornea has the ability to return to normal in most cases.

What are the Symptoms of Corneal 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:

  • The inability to correct to 20/20 with glasses or contacts
  • Complaints of shadows or ghosting
  • Squinting to see clearer
  • Prescription changes in astigmatic cylinder power and axis

How is Corneal Ectasia Treated?

Corneal ectasia is a rare but serious complication resulting from vision correction procedures such as LASIK and PRK.  Milan Eye Center provides various treatment options for patients including an innovative procedure called Corneal Cross-linking, or CXL.

Corneal cross-linking, or CXL, is a procedure which works to reverse the symptoms of corneal ectasia by strengthening and stabilizing the cornea. Corneal cross-linking 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

Another procedure we offer is Intacs. The Intacs implants are placed in the cornea outside of the patient’s line of sight to flatten the cornea and essentially reduce the cone or bulging that has developed.  These implants are designed to be placed in the periphery of the cornea at two-thirds depth and are surgically inserted through a small incision in the corneal stroma.  The primary goal of Intacs in keratoconus is to make the eye again tolerant of contact lenses and to avoid corneal transplantation.

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 sparring 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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