Penetrating keratoplasty for iatrogenic keratoconus after repeat myopic laser in situ keratomileusis: histologic findings and literature review.
We report a patient with a sufficiently thick cornea (593 microm) and no topographic signs of keratoconus preoperatively who developed iatrogenic keratoconus 2 months after repeat laser in situ keratomileusis (-4.00 -1.00 x 20) performed 5 months after the primary procedure (-10.50 -1.00 x 55). After penetrating keratoplasty, macrophotography showed severe multidirectional "macrostriae" of the stromal bed. On histologic evaluation, excessive thinning of the residual stromal bed to a minimum of 75 microm in the valleys and a maximum of 200 microm at the peaks of the macrostriae were documented. The flap thickness was 225 microm in the center. The thicker-than-intended flap (160 microm) is thought to be the cause of the severe complication of the LASIK procedure.
Seitz
Berthold
B
Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany. berthold.seitz@augen.imed.uni-erlangen.de
Rozsíval
Pavel
P
Feuermannova
Alena
A
Langenbucher
Achim
A
Naumann
Gottfried O H
GO
D000328:Adult; D003315:Cornea / Q000473:pathology* / Q000648:ultrastructure; D019781:Corneal Topography; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007640:Keratoconus / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D020731:Keratomileusis, Laser In Situ; D015948:Keratoplasty, Penetrating; D009216:Myopia / Q000601:surgery*; D012086:Reoperation