Cross-linking in post-LASIK ectasia

Post-LASIK ectasia, along with keratoconus and PMD, belongs to the family of corneal ectasias, and it’s easiest to view post-LASIK ectasia as a keratoconus that develops after laser eye surgery.

In laser refractive surgery, corneal tissue is removed with a laser to correct the refractive error or astigmatism. A normal cornea tolerates this easily. However, if too much tissue is removed, or if the cornea is endangered by other causes (hormones, pre-existing or undetected disease), then ectasia following LASIK, PRK and SMILE can still occur years after surgery. This ectasia is very similar to keratoconus and even has the same symptoms.

We were the first to show in 2012 that this ectasia can even occur 9 years after LASIK. It is all the more important that the surgeon has a great deal of experience in detecting such risk factors before surgery.

Until 2007, the only option for treating ectasia after LASIK and PRK was corneal transplantation (keratoplasty). This operation is serious (it requires general anaesthesia) and carries the risk of rejection.

However, in 2007, the world saw the very first patients with post-LASIK ectasia successfully treated with CXL. Since then, CXL has become the global gold standard for the treatment of this disorder.

When to treat?

In contrast to keratoconus (which progresses and then can be quiescent), ectasia progresses after LASIK. It should be treated as soon as the diagnosis has been made.