Ectasia Committee formulates recommendations, options for disorder

Eric Donnenfeld, MD, described the current recommendations formulated by the newly created Ectasia Committee at the annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS).

A team of individuals from ASCRS, the American Academy of Ophthalmology, and the International Society of Refractive Surgery formed the committee.

"The Ectasia Committee was formed with the purpose of summarizing the existing knowledge regarding ectasia and refractive surgery and for the benefit of ophthalmologists performing refractive surgery to reduce the occurrence of ectasia and improve patient outcomes," said Dr. Donnenfeld, of Ophthalmic Consultants of Long Island, New York, and Connecticut. "The committee wanted to describe the different options and the prognosis for patients and provide a summary document of what will help to reduce the incidence of the disorder."

The committee first concluded that topography should be performed on all patients before refractive surgery and that the computer-generated indices are not necessarily accurate. There are no absolute indicators for patients who go on to develop ectasia. In addition, the development of ectasia can mean that the procedure was contraindicated but can also mean that the procedure was not necessarily contraindicated.

The committee also concluded that ectasia is a known risk factor of laser vision correction, but this may not be true of surface ablation. The occurrence of ectasia after laser vision correction does not mean that the procedure was contraindicated or that the standard of care was violated, Dr. Donnenfeld reported.

Other conclusions were that forme fruste keratoconus is a topographic diagnosis and is not a variant of keratoconus. Forme fruste keratoconus implies subclinical disease with the potential with or without surgery to progress to clinical keratoconus.

"Topographic risk factors for ectasia include asymmetric inferior corneal steepening, an asymmetric bowtie topographic pattern that is skewed above or below the horizontal meridian, and a topographic inferior crab claw pattern," he said. "We suggest that surface ablations be considered in patients with mild topographic findings or not do the procedure, but that in mild cases surface ablation can be considered as long as the patients provide informed consent after receiving documentation of the abnormal topography."

In addition, the committee recommended that surgeons review the topography before laser vision correction and that intraoperative pachymetry be performed in all cases in which the residual stromal bed is approximately 250 microns.