Topographic, Tomographic, and Aberrometric Characteristics of Post‐LASIK Ectasia

PURPOSE: To report the refractive, topographic, tomographic, and aberrometric characteristics of post-LASIK ectasia; to compare these characteristics with normal post-LASIK controls; and to propose a comprehensive system to grade the severity of post-LASIK ectasia. METHODS: The refraction, corrected distance visual acuity (CDVA), magnitude, and location of the steepest and thinnest point on the cornea, the highest anterior and posterior surface elevation, the radius of best fit sphere, corneal asphericity, and corneal aberrations were measured in 50 eyes of 29 patients with post-LASIK ectasia. These were compared with corresponding parameters in 50 eyes that did not develop ectasia for more than 1 year after LASIK. A logistic regression analysis was used to create a scoring system to grade the severity. RESULTS: Eyes with post-LASIK ectasia had significantly higher myopia with astigmatism and a lower CDVA than control eyes. Mean topographic toricity was 3.4 ± 1.9D, mean keratometry at the steepest point was 55.32 ± 6.63D, mean highest posterior elevation was 69.72 ± 3 μm, and mean coma was -2.06 ± 1.2 μm. All these parameters were significantly higher than corresponding values in the control group (p < 0.001 in all). Spherical aberration was more negative and the change in asphericity indicated significantly greater prolate shape of the cornea in eyes with post-LASIK ectasia compared to controls. Five parameters, namely, CDVA, spherical equivalent, highest posterior corneal elevation, spherical aberration, and corneal asphericity, were identified as significant predictors of post-LASIK ectasia and used to create a scoring system. CONCLUSION: Post-LASIK ectasia is characterized by significant changes in refraction, topography, tomography, and aberrometry. The proposed scoring system may be useful in diagnosing, grading, and monitoring post-LASIK ectasia.