Corneal Ectasia
Publication Date: November 1, 2018
Last Updated: March 14, 2022
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
Patients with unstable refractions should be evaluated for evidence of corneal ectasia.
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The ophthalmologist needs to measure many aspects of visual function, since best-corrected visual acuity (BCVA) may not completely characterize visual function in these patients.
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Signs of corneal ectasia can include, but are not limited to: inferior steepening, superior flattening, skewing of radial axes on power topographic maps, abnormal islands of elevation anteriorly and/or posteriorly on tomography and decentered or abnormal corneal thinning or rate of change of corneal thickening from the center to the periphery.
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Prior to refractive surgery, corneal topography and tomography performed following a period of contact lens abstinence should be reviewed for evidence of irregular astigmatism or abnormalities suggestive of keratoconus or other forms of corneal ectasia.
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When corneal ectasia occurs following keratorefractive surgery, it is usually determined that the residual stromal bed following surgery was thinner than expected, that the flap was thicker than expected, or that the patient had preoperative signs of subclinical ectasia by tomography.
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It is impossible preoperatively to identify all patients at risk for postkeratorefractive corneal ectasia. Those with risk factors for ectasia may not develop the condition following laser vision correction surgery and some without obvious risk factors may develop ectasia following laser vision correction.
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Corneal cross-linking (CXL) reduces the risk of progressive ectasia in patients with keratoconus (particularly in its early stages) and stabilizes the corneal. It also stabilizes cases of corneal ectasia occurring after keratorefractive surgery.
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Deep anterior lamellar keratoplasty (DALK) may be used to treat ectatic disease. Its advantages include no risk for endothelial rejection and a low risk of stromal rejection. Progressive endothelial cell loss following DALK may also be less than following penetrating keratoplasty.
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Recommendation Grading
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Overview
Title
Corneal Ectasia
Authoring Organization
American Academy of Ophthalmology
Publication Month/Year
November 1, 2018
Last Updated Month/Year
June 9, 2022
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Optometrist, optician, nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management
Diseases/Conditions (MeSH)
D003316 - Corneal Diseases, D007640 - Keratoconus
Keywords
vision loss, corneal ectasia, Lasik, Keratoconus
Methodology
Number of Source Documents
173
Literature Search Start Date
March 1, 2017
Literature Search End Date
June 1, 2018