Corneal Ectasia

Publication Date: November 1, 2018

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

Disclaimer

Overview

Title

Corneal Ectasia

Authoring Organization

Publication Month/Year

November 1, 2018

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