45yo Gent post hyperopic LASIK: is this keratectasia? Kanellopoulos MD

We will carefully review the cornea imaging in this 45-year-old gentleman who had undergone hypertropic LASIK seven years ago and currently carries the diagnosis of post-LASIK ectasia and recommendation for CXL. Careful analysis of Scheimpflug imaging, Anterior segment OCT (with the Optovue Avanti) as well as Placido disc reflection topography in combination with careful slit-lamp biomicroscopy and review of the significant in this case Eye disease history will conclude that indeed there is a cornea irregularity in the left eye, but not ectasia: the cornea in the left eye. has become irregular mimicking ectasia due to significant scarring within the flap interface from severe EKC that he suffered from about five years ago! Additionally the epithelial maps on the left underline severe external disruption confirmed by avid mucous present on the left lower lid margin and demo by the patient himself of vigorous mucous-fishing
So our diagnosis roster has changed!
1-post hyperopic LASIK
2-significant irregular post EKC scarring creating an annular confluent area superotemporally in the cebter of the cornea in the left
3-significant mucous fiahing syndrome in the left
4-significant acne rosecea blepharitis in both
5-small pterygiae in both
This case illustrates very well Our work with cornea imaging( through oir oast topography-guided university day courses) focusing on the understanding of the principles of each imaging device, and how can this principles can become the “toolbox” for the astute clinician to hone on the correct diagnosis.
Our treatment plan in this case:
Topical cyclosporine drops for a year to resolve much of the cornea EKC-related scarring along with topical corticosteroids. When the pathology improves or at least shows signs of stability we will offer a topography-guided surface ablation without CXL in order to imporve the compromised cornea optics!
I hope you find this presentation interesting