Corneal Ectasia
Publication Date: February 12, 2024
Last Updated: February 16, 2024
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
Patients with unstable refractions should be evaluated for evidence of corneal ectasia. (, , )
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Since corrected distance visual acuity (CDVA) may not completely characterize visual function in patients with corneal ectasia, the ophthalmologist needs to include other measures such as corneal topography and tomography. (, , )
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Signs of corneal ectasia can include, but are not limited to, inferior steepening, superior flattening, skewing of radial axes on power topographic maps, abnormal islands of elevation anteriorly and/or posteriorly on tomography, and decentered or abnormal corneal thinning and/or abnormal rate of change of corneal thickening from the center to the periphery. (, , )
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Patients being evaluated for keratorefractive surgery should be evaluated for corneal ectasia following a period of contact lens abstinence. Corneal topography and tomography should be reviewed for evidence of irregular astigmatism or abnormalities suggestive of keratoconus or other forms of corneal ectasia. Overall, the risk of corneal ectasia is lower after photorefractive keratectomy (PRK) and small-incision lenticule extraction (SMILE) compared with laser in-situ keratomileusis (LASIK). This has been attributed to higher residual stromal bed thickness and absence of the corneal flap in PRK. (, , )
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Corneal cross-linking (CXL) reduces the risk of progressive ectasia in patients with keratoconus. It also stabilizes corneal ectasia occurring after keratorefractive surgery but is generally not as effective in this latter setting. Corneal cross-linking is the recommended treatment for progressive keratoconus because it stabilizes the cornea and reduces the risk of progressive ectasia. It also stabilizes corneal ectasia occurring after keratorefractive surgery but is generally less effective in this later setting. (, , )
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The long-term stabilizing effect of CXL may be more cost effective than corneal transplantation. (, , )
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Specialty contact lenses, including hybrid and scleral lenses, should be trialed for visual rehabilitation prior to keratoplasty and may delay and even eliminate the need for corneal transplantation. (, , )
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Penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) may be used to treat corneal ectasia. The advantages of DALK include no risk for endothelial rejection and lower risk of globe rupture than with PK. The progressive endothelial cell loss following DALK may also be less than the loss following PK. (, , )
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Recommendation Grading
Overview
Title
Corneal Ectasia
Authoring Organization
American Academy of Ophthalmology
Publication Month/Year
February 12, 2024
Last Updated Month/Year
February 19, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Optometrist, optician, nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management
Diseases/Conditions (MeSH)
D003316 - Corneal Diseases, D007640 - Keratoconus
Keywords
vision loss, corneal ectasia, Lasik, Keratoconus
Source Citation
Jhanji V, Ahmad S, Amescua G, Cheung AY, Choi DS, Lin A, Mian SI, Rhee MK, Viriya ET, Mah FS, Varu DM; American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease Panel. Corneal Ectasia Preferred Practice Pattern®. Ophthalmology. 2024 Feb 12:S0161-6420(24)00010-1. doi: 10.1016/j.ophtha.2023.12.038. Epub ahead of print. PMID: 38349299.
Supplemental Methodology Resources
Methodology
Number of Source Documents
216
Literature Search Start Date
March 3, 2022
Literature Search End Date
June 7, 2023