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Stromal bed thickness most important factor in post-LASIK keratectasia, study suggests

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LISBON, Portugal — The thickness of the residual stromal bed after LASIK is the primary factor in the development of keratectasia, according to a study presented here.

Teresa Pacheco, MD, told attendees at the European Society of Cataract and Refractive Surgeons meeting that in reviewing data on 2,500 eyes that had undergone LASIK, she and co-workers identified six eyes with postoperative keratectasia. The researchers evaluated the thickness of the residual stromal bed in the six eyes and compared those with three post-LASIK eyes that had a residual stromal bed thickness of less than 350 µm but no ectasia.

In three of the eyes with keratectasia, the corneal flap had to be removed because of complications, she said. In all the eyes with keratectasia, the preoperative myopia was higher than 8 D, and the calculated residual stromal bed was less than 250 µm in thickness.

In the three eyes with no ectasia, refraction remained stable as long as 6 to 9 years after surgery, she said.

“Our conclusion is the flap is not important to corneal stability after LASIK,” Dr. Pacheco said. “The stromal bed is the decisive factor, although this does not preclude the development of keratectasia after LASIK.”