A rare combination of late-onset post-LASIK keratectasia after early-onset central toxic keratopathy

This case report details a 44-year-old male who experienced rare complications following LASIK surgery. Initially, the patient underwent LASIK to correct myopic astigmatism. Post-operatively, he developed early-onset central toxic keratopathy (CTK), characterized by reduced vision and a hyperopic shift. While the CTK symptoms eventually improved, the patient later developed late-onset post-LASIK keratectasia four years after the initial surgery. This sequence of events is particularly noteworthy as it is the first reported case of bilateral keratectasia preceded by CTK after LASIK.

The article explores potential factors contributing to this outcome. Although the exact cause of CTK is uncertain, it's been linked to intraoperative corneal toxicity. Similarly, post-LASIK keratectasia is associated with biomechanical weakening of the cornea. In this specific case, the authors suggest that both the LASIK procedure itself and the subsequent CTK may have contributed to corneal biomechanical deterioration, ultimately leading to the development of late-onset keratectasia. They also note that the patient's Percent Tissue Altered (PTA) value was relatively high, potentially predisposing him to postoperative keratectasia.

Ultimately, the patient was successfully fitted with gas permeable (GP) contact lenses to address the vision issues caused by keratectasia, achieving a CDVA of 20/20 in both eyes. This case highlights a potential link between early CTK and late-onset keratectasia after LASIK, suggesting that CTK could contribute to the long-term biomechanical instability of the cornea. The authors emphasize the importance of careful monitoring and consideration of risk factors like PTA in LASIK candidates.