Bilateral loss in the quality of vision associated with anterior corneal protrusion after hyperopic LASIK followed by intrastromal femtolaser-assisted incisions.

A patient was treated bilaterally for hyperopia (twice in the right eye and 3 times in the left eye) using laser in situ keratomileusis (LASIK) and achieved stable vision. Preoperatively, there was no known risk factor for ectasia. Three years after the last LASIK enhancement treatment, intrastromal femtolaser-assisted incisions (Intracor procedure using the Technolas femtosecond laser) were made bilaterally. After the procedure, a severe loss in the corrected distance visual acuity and in the quality of vision occurred, associated with a topography pattern suggestive of isolated anterior central protrusion. This case suggests that intrastromal femtosecond incisions in eyes that have had hyperopic LASIK should be done with caution, as there is no certainty about how the treated corneas will respond.