Corneal ectasia after laser in situ keratomileusis after laser thermal keratoplasty.

PURPOSE To report a case of corneal ectasia following hyperopic laser in situ keratomileusis in a patient who had previous laser thermal keratoplasty. METHODS Case report. RESULTS We report a case of a 66-year-old emmetropic man initially presented with complaint of difficulty reading without correction. Laser thermal keratoplasty (LTK) was performed on the non-dominant right eye, resulting in successful monovision. Three years later, the patient presented with decreased unaided near vision caused by hyperopic regression of the LTK. Conventional hyperopic laser in situ keratomileusis (LASIK) was performed, again resulting in successful monovision. More than three years later, the patient returned with worsening near vision. A focal corneal ectasia was noted in the same location as the 6 o'clock LTK leukoma. CONCLUSIONS To our knowledge, this is the first report of ectasia occuring after LASIK following LTK. Consideration should be given to performing photorefractive keratectomy (PRK) instead of LASIK following thermal keratoplasty.