Mohammadpour suggests that our patient may have had subclinical keratoconus. He states that the difference between refractive and topographic astigmatism, the absence of Orbscan data, and the asymmetry in astigmatism between the 2 eyes were indications that the patient had subclinical keratoconus. None of these parameters has been reported (in an evidence-based study) as an indication of subclinical keratoconus.1 Furthermore, our patient had none of the post-LASIK corneal ectasia risk factors (such as preoperative abnormal topography, preoperative corneal thickness less than 500 μm, or residual corneal bed thickness less than 250 μm, excessive flap thickness, or high attempted correction) reported in the major review studies of post-LASIK corneal ectasia.2–4
In the fourth comment, Mohammadpour says that we did not pay attention to the patient's corneal biomechanics. While we agree that this is an important topic, it was not the purpose of the article to discuss this issue. It was a case report, with limited available space, insufficient to explain the entire background of post-LASIK corneal ectasia. Furthermore, we performed LASIK in this eye and PRK in the fellow eye because the assignment of eyes in a randomized prospective study is not the choice of the surgeon.
In the fifth comment, Mohammadpour notes that we did not cite his article. When we submitted the manuscript, his article had not been published. Had we known about it, we would have included it as a good example of a patient with subclinical keratoconus—preoperative pachymetry of 447 μm and intended flap thickness of 130 μm—who developed post-LASIK corneal ectasia, as one would expect.1–4
1. Binder PS. Ectasia after laser in situ keratomileusis. J Cataract Refract Surg. 2003;29:2419-2429.
2. Randleman JB. Post-laser in-situ keratomileusis ectasia: current understanding and future directions. Curr Opin Ophthalmol. 2006;17:406-412.
3. Randleman JB, Russell B, Ward MA, et al. Risk factors and prognosis for corneal ectasia after LASIK. Ophthalmology. 2003;110:267-275.
4. Rabinowitz YS. Videokeratographic indices to aid in screening for keratoconus. J Refract Surg. 1995;11:371-379.