Citation Information :
Ramos I, Ambrósio R, Mazzeo TJ, Sena Jr NB, Canedo AL, da Silva RS, Colombini G. Post-LASIK Ectasia associated with Pigmentary Glaucoma: Tomographic and Biomechanical Characterization. Int J Kerat Ect Cor Dis 2018; 7 (1):61-65.
Aim: To report a case of bilateral post-laser in situ keratomileusis (LASIK) ectasia associated with pigmentary glaucoma (PG), in which intraocular pressure (IOP) assessment had been relentlessly underestimated by Goldmann's applanation tonometry (GAT).
Materials and methods: Case report and prospective literature review.
Results: The patient presented for second opinion regarding ectasia in the right eye, while ectasia was diagnosed in the left eye. Uncorrected visual acuity was 20/40 oculus dexter (OD) and 20/200 oculus sinister (OS). Distance corrected visual acuity was 20/20 in OD and 20/50 OS; GAT was 18/18 mm Hg. Slitlamp biomicroscopy was relevant for a well-positioned superior hinge cornel flap and Krukenberg's spindle in both eyes, and Fleischer's ring in the left eye. Corneal compensated IOP was 47.8 and 43.8 mm Hg in OD and OS as measured by the ocular response analyzer (ORA; Reichert, Buffalo, New York, USA). The biomechanicalcompenated (IOPb) was 62.9 mm Hg OD and unmeasured OS by Corvis ST (Oculus; Wetzlar, Germany), which also demonstrated attenuated corneal deformation OU. Pentacam confirmed corneal ectasia in both eyes, being considerably worse in OS. One day after initiation of a fixed combination of beta blocker and carbonic anhydrase inhibitor, the patient noted significant improvement of vision with reduction of IOPb to 13 and 13.5 mm Hg in OD and OS respectively. Patient referred improvement in quality of vision and there was marked reduction on corneal scatter, thickness, and curvature.
Conclusion: Pigment dispersion syndrome (PDS) and PG may coexist with corneal ectasia. Careful consideration of the corneal impact on IOP assessment is mandatory when evaluation patients after laser vision correction (LVC). The IOP normalization may improve corneal ectasia in patients with coexisting glaucoma or ocular hypertension.
Binder PS. Analysis of ectasia after laser in situ keratomileusis: risk factors. J Cataract Refract Surg 2007 Sep;33(9): 1530-1538.
Randleman JB, Trattler WB, Stulting RD. Validation of the ectasia risk score system for preoperative laser in situ keratomileusis screening. Am J Ophthalmol 2008 May;145(5): 813-818.
Giri P, Azar DT. Risk profiles of ectasia after keratorefractive surgery. Curr Opin Ophthalmol 2017 Jul;28(4):337-342.
Broman AT, Congdon NG, Bandeen-Roche K, Quigley HA. Influence of corneal structure, corneal responsiveness, and other ocular parameters on tonometric measurement of intraocular pressure. J Glaucoma 2007 Oct-Nov;16(7):581-588.
Clement CI, Parker DG, Goldberg I. Intra-ocular pressure measurement in a patient with a thin, thick or abnormal cornea. Open Ophthalmol J 2016 Feb;10:35-43.
Duch S, Serra A, Castanera J, Abos R, Quintana M. Tonometry after laser in situ keratomileusis treatment. J Glaucoma 2001 Aug;10(4):261-265.
Haw WW, Manche EE. Iatrogenic keratectasia after a deep primary keratotomy during laser in situ keratomileusis. Am J Ophthalmol 2001 Dec;132(6):920-921.
Spadea L, Cantera E, Cortes M, Conocchia NE, Stewart CW. Corneal ectasia after myopic laser in situ keratomileusis: a long-term study. Clin Ophthalmol 2012 Nov;6:1801-1813.
Santhiago MR. Percent tissue altered and corneal ectasia. Curr Opin Ophthalmol 2016 Jul;27(4):311-315.
Deol M, Taylor DA, Radcliffe NM. Corneal hysteresis and its relevance to glaucoma. Curr Opin Ophthalmol 2015 Mar;26(2):96-102.
Ambrosio JR, Ramos I, Luz A, Faria FC, Steinmueller A, Krug M, Belin MW, Roberts CJ. Dynamic ultra high speed Scheimpflug imaging for assessing corneal biomechanical properties. Braz J Ophthalmol 2013 Mar-Apr;72(2):99-102.
Hirasawa K, Matsuura M, Murata H, Nakakura S, Nakao Y, Kiuchi Y, Asaoka R. Association between corneal biomechanical properties with ocular response analyzer and also CorvisST tonometry, and glaucomatous visual field severity. Transl Vis Sci Technol 2017 Jun;6(3):18.
Correia FF, Ramos I, Roberts CJ, Steinmueller A, Krug M, Ambrosio R Jr. Impact of chamber pressure and material properties on the deformation response of corneal models measured by dynamic ultra-high-speed Scheimpflug imaging. Arq Bras Oftalmol 2013 Oct;76(5):278-281.
Cronemberger S, Guimaraes CS, Calixto N, Calixto JM. Intraocular pressure and ocular rigidity after LASIK. Arq Bras Oftalmol 2009 Jul-Aug;72(4):439-443.
Razeghinejad MR, Nouri-Mahdavi K, Perera S. Primary open angle glaucoma and post-LASIK keratectasia. J Ophthalmic Vis Res 2010 Jul;5(3):196-201.
Tsai AS, Loon SC. Intraocular pressure assessment after laser in situ keratomileusis: a review. Clin Exp Ophthalmol 2012 Apr;40(3):295-304.
Niyadurupola N, Broadway DC. Pigment dispersion syndrome and pigmentary glaucoma–a major review. Clin Exp Ophthalmol 2008 Dec;36(9):868-882.