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Pregnancy may be a significant risk factor for late-onset post-LASIK ectasia
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ROME — Pregnancy may trigger late-onset keratectasia up to 9 years after LASIK surgery, according to a cornea specialist here.
“There are factors that temporarily modify corneal biomechanics, and one of them is estrogens. In vitro and ex vivo studies showed that estrogens upregulate collagenase and therefore weaken corneal biomechanical strength,” Farhad Hafezi, MD, said at the joint Refractive.online and SICCSO meeting.
Farhad Hafezi
During pregnancy, estrogens increase by a factor of 30,000. A high number of reports from eye clinics show pregnancy-related exacerbation of keratoconus and iatrogenic ectasia, Hafezi said.
The first case Hafezi encountered was a woman treated with LASIK in 2000. She was stable for 2 years, then showed decompensation with significant loss of vision during her first pregnancy. She received cross-linking treatment, and during the following 2 years she was stable and had a significant reduction in keratometry readings. But then during a second pregnancy she decompensated again.
Hafezi published a series of five retrospective cases of women who developed ectasia at various intervals after LASIK surgery, ranging from 4 to 9 years.
“The interesting concept is that all of them developed ectasia after pregnancy started,” Hafezi said.
He said he now prefers not to offer LASIK to young women who are borderline candidates and wish to become pregnant in the next 2 to 4 years.
Further systematic studies should investigate the effects of pregnancy on corneal biomechanics, Hafezi said.