Ectasia in a thin cornea (1999)
This case is my oldest documented report of corneal ectasia. LASIK was performed in 1999 in a 30 yo man, and the preoperative topography screening was obtained using the slit scanning based ORBSCAN I instrument (the first version of the device did not have a Placido disk). Preoperatively, the cornea of the right eye (RE) exhibited low keratometry values and with the rule astigmatism. The cornea of the left eye (LE) showed some central irregularity, with an overall pattern of oblique astigmatism.
The right and left corneas were thin (490 microns bilaterally). LASIK was performed with a mechanical microkeratome and 87 microns of central ablation in the LE and 75 microns in the RE.
Ectasia occurred approximately 4 years postoperatively in the right eye. The left eye topography exhibited some central irregularities, evocative of the possibility of an early ectatic process.
The retrospective analysis of this case reveals that many warning signs were present at the preoperative stage of the evaluation: the corneas were thin, the thinnest point of the right cornea was decentered inferiorly; there was poor Right and Left eye symmetry.
The first report of ectasia was published in 1998 by Theo Seiler, and most LASIK surgeons were not aware of this complication in the late 90s.