Keratectasia after bilateral laser in situ keratomileusis in a patient with previous radial and astigmatic keratotomy Gonzalo Mun ˜oz, MD, PhD, Robert Monte ´s-Mico ´, OD, MPhil, Ce ´sar Albarra ´n-Diego, OD, Jorge L. Alio ´, MD, PhD We describe a case of bilateral keratectasia after laser in situ keratomileusis (LASIK) in a patient with previous radial keratotomy and astigmatic keratotomy. The best spectacle-corrected visual acuity (BSCVA) was 20/25 in both eyes. After uneventful LASIK was performed in both eyes for low myopic astigmatism, the patient presented with progressive myopia and astigmatism and a BSCVA of 20/50 in both eyes. Videokeratography showed progressive deformation of the cornea, increasing K-values over 50.0 diopters, and irregular astigmatism. The best corrected visual acuity in both eyes improved to 20/25 with rigid poly(methyl methacrylate) contact lenses. J Cataract Refract Surg 2005; 31:441–445 ª 2005 ASCRS and ESCRS I atrogenic corneal ectasia after laser in situ keratomi- leusis (LASIK) is a progressive deformation of the cornea. Although it rarely occurs, it has serious con- sequences such as progressive myopia, irregular astig- matism, and loss of best spectacle-corrected visual acuity (BSCVA). Significant risk factors for keratectasia after LASIK include high myopia, forme fruste keratoconus, a thicker than normal flap, irregular corneal thickness, a cornea thinner than 500 mm, a greater amount of tissue ablation, larger optical zones, and different ablation rates. 1–4 Because the flap and the stromal bed of the cornea may thin after LASIK, a residual stromal bed thickness of 250 mm can also lead to postoperative keratectasia. 5 Although not common, keratectasia has also been described after primary corneal incisional procedures such as radial keratotomy (RK) and astig- matic keratotomy (AK). 6 We describe a patient with previous incisional cor- neal surgery and residual ametropia who had bilateral simultaneous LASIK and subsequently developed bi- lateral keratectasia. This case suggests that previous corneal incisional surgery can be a significant risk factor for the development of keratectasia after LASIK. Case Report A 28-year-old man presented to our clinic with a refractive error of ÿ2.75 ÿ3.00  35 in the right eye and ÿ1.00 ÿ2.00  180 in the left eye 8 years after he had bilateral RK and AK, which were performed at another center. The preoperative refractive error was ÿ4.00 ÿ2.00  90 in both eyes. The BSCVA was 20/25 and the central corneal thickness was 540 mm in both eyes. Figure 1 shows the location of the incisions on the cornea in both eyes; 4 radial incisions were placed at the 45  –225  and 135  –315  axes, and 2 pairs of arcuate incisions were placed at the 0  – 180  axis. Although no information on the depth of the incisions was available, slitlamp evaluation indicated they were nearly 100% corneal thickness. Based on the patient’s subjective comments and a spectacle prescription from 5 years previously, the refraction had not changed and thus was considered stable. Accepted for publication May 21, 2004. From the Refractive Surgery Department, Instituto Oftalmolo´gico de Alicante (Mun˜oz, Monte´s-Mico´, Alio´), and the Refractive Surgery Unit, Hospital NISA Virgen del Consuelo (Mun˜oz, Monte´s-Mico´, Albarra´n-Diego), Valencia, Spain. None of the authors has a financial or proprietary interest in any material or method mentioned. Reprint requests to Gonzalo Mun˜oz, Instituto Oftalmolo´gico de Alicante, Avenida Denia 111, 03015 Alicante, Spain. E-mail: gon.munoz@ono.com. ª 2005 ASCRS and ESCRS 0886-3350/05/$-see front matter Published by Elsevier Inc. doi:10.1016/j.jcrs.2004.05.057