Clinical characteristics of post-refractive surgery corneal ectasia

Aims/Purpose: The aim of this study was to explore the clinical characteristics, visual acuity (VA), and topographic patterns in patients who developed corneal ectasia (CE) following myopic laser vision correction (LVC).

Methods: We conducted a retrospective review of medical records for patients diagnosed with CE after laser vision correction between 2009 and 2023 at a tertiary hospital in Korea. We collected various data, including patient demographics, medical history, the type of refractive surgery and postoperative periods., VA at their initial and final visits, refractive errors, and topographic biometric data.

Results: In total, 36 eyes of 28 patients (13 females and 15 males) were included, and 8 (28.5%) cases were bilaterally involved. The most common type of surgery was LASIK (24 patients, 85.7%), while the remaining patients underwent LASEK (3 patients, 10.7%) or PRK (1 patient, 3.6%). In unilaterally involved eyes (20 eyes), VA, spherical equivalent (SE), and astigmatism of CE-affected eyes were significantly different from those of eyes with uninvolved eyes (all p < 0.001). In eyes with over 12 months of follow-up observation (12 eyes of 9 patients), no significant progression was noted in VA (p = 0.392), SE (p = 0.675), astigmatism (p = 0.737), and topographic parameters.

Conclusions: CE can develop even after comprehensive preoperative screening following LVC. This condition can significantly impact patients' quality of life by substantially reducing VA. Moreover, considering the spectrum of diseases that keratoconus represents, there is a possibility that CE may cease to progress after a certain age. Further investigations are required to understand the progression of CE concerning age in affected patients.