Reply: We would like to thank Drs. Elies, Coret, and Cavero for calling attention to the importance of patient evaluation and definition of patient selection criteria in LASIK. Initially, it was believed that high degrees of myopia could be corrected by LASIK,1 but recent studies suggest that LASIK may cause iatrogenic keratectasia in high myopia (between −10.0 and −13.5 diopters [D])2 and even in low to moderate myopia.3
In our article, we presented a case in which the LASIK procedure was performed by another surgeon in a private laser surgery center. The surgeon clearly made a mistake in the calculation of ablation depth and caused iatrogenic keratectasia. Although the purpose of this case report was to present a corneal iron ring associated with iatrogenic keratectasia, we have described all the data gathered from the patient's intraoperative record and postoperative examinations to call attention to miscalculation during the patient evaluation.
Akif Ozdamar MD
1. Pérez-Santonja JJ, Bellot J, Claramonte P, et al. Laser in situ keratomileusis to correct high myopia. J Cataract Refract Surg 1997; 23:372-385
2. Seiler T, Koufala K, Richter G. Iatrogenic keratectasia after laser in situ keratomileusis. J Refract Surg 1998; 14:312-317
3. Amoils SP, Deist MB, Gous P, Amoils PM. Iatrogenic keratectasia after laser in situ keratomileusis for less than −4.0 to −7.0 diopters of myopia. J Cataract Refract Surg 2000; 26:967-977