Keratectasia after treating presbyopia with INTRACOR followed by SUPRACOR enhancement

To report a case of unilateral keratectasia after INTRACOR, which was followed by an additional excimer LASIK enhancement with a new presbyopia-correcting ablation profile.

The non-dominant eye of a 49-year-old man with emmetropia was treated with the INTRACOR procedure using the Technolas femtosecond laser (Technolas Perfect Vision GmbH, Munich, Germany) for presbyopia. Neither eye had risk factors for keratectasia. Two years later, a presbyopia-correcting LASIK (SUPRACOR LASIK; Technolas Perfect Vision GmbH) enhancement was performed in the same eye because of deteriorated distance and near visual acuity.

The eye treated with INTRACOR followed by SUPRACOR LASIK developed marked keratectasia topographically limited to the area altered by INTRACOR, whereas the fellow eye remained stable and still has no signs of keratoconus.

This case emphasizes the incomplete knowledge of the risk factors for keratectasia following INTRACOR alone and in combination with a SUPRACOR LASIK enhancement. It also suggests that the combined weakening effect of both procedures on corneal mechanical stability may be too strong even in the absence of established risk factors for LASIK surgery.