Lack of progression of ectasia seven years after LASIK in a highly myopic keratoconic eye.

PURPOSE: To report a patient with clinically evident keratoconus with a preoperative spherical equivalent refraction of more than -10.00 diopters (D) who underwent successful LASIK with no evidence of progression of ectasia 7 years after surgery.

METHODS

Interventional case report.

RESULTS

A patient with clinically evident keratoconus in his left eye underwent bilateral LASIK. Preoperative best spectacle-corrected visual acuity (BSCVA) in the left eye was 20/25 with a manifest refraction of -8.50 -3.25 x 126. Seven years later he presented complaining of progressive loss of visual acuity in his left eye. A significant posterior subcapsular and nuclear cataract was present in the left eye. There was no evidence of ectasia on topography. Cataract surgery was performed and BSCVA retumed to 20/20.

CONCLUSIONS

LASIK can be successful in some eyes with keratoconus, even when deep ablations are performed. It is not appropriate to conclude from this case that LASIK is safe in eyes with keratoconus. This case raises an important question: why do some eyes with normal preoperative topography develop ectasia after LASIK, whereas other eyes with significant keratoconus preoperatively remain stableert ke after LASIK?