Iatrogenic Keratectasia Following Laser in situ Keratomileusis

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Abstract
PURPOSE: To evaluate keratectasia after laser in situ keratomileusis (LASIK) for high myopia. METHODS: A 49-year-old male patient with myopia of -23.50 D in both eyes underwent LASIK with a Summit Technology Apex Plus excimer laser. A Moria manually-guided MDSC microkeratome was used. Preoperative corneal topography in both eyes did not reveal underlying or fruste form of keratoconus. Four months after LASDX, a progressive keratectasia occurred in right eye and after 12 months, in left eye. Corneal transplantation was performed in both eyes. RESULTS: Histological and ultrastructural examinations were performed on one corneal button. The analysis showed regular stromal morphology and cellularity, with no sign of inflammation. The morphometric analysis showed an overall thickness of 334 /cm, with a flap of 262 /on and a stromal residual bed of 72 ?a\, in the center of the button. CONCLUSION: A LASIK corneal flap made with a planned 120-/tm plate turned out histologically to be approximately 260 ??\ thick, in an eye with a refractive correction of -23.50 D. The excessive flap thickness and excessive ablation produced progressive keratectasia requiring a penetrating keratoplasty. [J Refract Surg 2002;18:475-480]