First Author: S.Taneri GERMANY
Co Author(s): S. Oehler J. Koch
Purpose:
To report a case of unilateral keratectasia after Intracor treatment for presbyopia, which was followed by an additional SupraCor-LASIK enhancement 2 years later.
Setting:
Zentrum für Refraktive Chirurgie, Augenabteilung am St. Franziskus Hospital, Münster, Germany
Methods:
Unilateral Intracor treatment of the non-dominant eye of an emmetropic presbyopic male patient was performed because he was needing +1.5D of near addition. Two years later a SupraCor LASIK enhancement was performed because of deteriorated distance and near vision. Mean outcome measures: corrected and uncorrected distance visual acuity, near visual acuity, and corneal topography. Neither eye had risk factors for keratectasia; both eyes had a score of zero on the Randleman risk factor for keratectasia scale before IntraCor surgery (although there was an inferior steepening in the eye to be treated of 1.29D in the measurement obtained with the Tomey topographer but not with the Wavelight Allegro Oculyzer that would mean a score of 3; which corrosponds to moderate risk).
Results:
Only the eye treated with IntraCor followed by SupraCor LASIK developed marked keratectasia topographically limited to the area altered by IntraCor, while the partner eye has remained stable and still has no signs of keratoconus.
Astigmatism increased from 0.75D to 1.75D from the third day post IntraCor to two years postop. Minimum keratometry (Kmin) changed from 44.7D preop to 45.9D two years after IntraCor. Maximum keratometry (Kmax) changed from 46.9D preop to 48.1D two years after IntraCor (Wavelight Allegro Oculyzer). Uncorrected near visual acuity changed from J1 one day post IntraCor to J5 two years post IntraCor.
Kmin changed from 47.5D pre SupraCor to 54.3D one year after SupraCor-LASIK. Kmax changed from 49.5D pre SupraCor to 59.2D one year after SupraCor-LASIK (Orbscan). Uncorrected distance visual acuity changed one year after SupraCor-LASIK from 0.5 to 0.2 (decimal scale). Best corrected visual acuity decreased from 1.0 to 0.2 pre IntraCor to one year post SupraCor.
Conclusions:
We believe this is the first case of keratectasia reported in the literature after Intracor followed by Supracor-LASIK. It emphasizes our incomplete knowledge of the risk factors for keratectasia following Intracor alone and in combination with a Supracor enhancement and suggests that the combined weakening effect of both procedures on corneal mechanical stability may be too strong even in the absence of established risk factors for LASIK surgery. FINANCIAL DISCLOSURE?: No
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