Corneal ectasia after intrastromal presbyopic surgery

To report histopathologic findings in a case of bilateral corneal ectasia following intrastromal femtosecond laser presbyopia surgery.

Case report.

A 56-year-old patient was referred for bilateral corneal ectasia. He was treated for hyperopia using LASIK twice in both eyes. A bilateral femtosecond laser intrastromal presbyopia correction was secondarily performed. The patient complained of progressive loss of distance visual acuity shortly after. Corneal topography showed a bilateral central corneal protrusion. Rigid contact lenses were successfully fitted on the right eye and, because the patient still complained, a deep anterior lamellar keratoplasty was performed in the left eye. Light and electronic microscopy of the corneal button revealed that the inner intrastromal incision crossed the LASIK interface and led to stromal bed dehiscence.

This case illustrates that intrastromal refractive surgery should not be recommended in eyes previously treated by lamellar refractive surgery.