AAO Preferred Practice Pattern 2018 for Corneal Ectasia
The American Academy of Ophthalmology (AAO) has recently updated its 2013 Preferred Practice Pattern (PPP) guidelines for Corneal ectasia.

Corneal ectasias are associated with decreased uncorrected visual acuity (UCVA), an increase in ocular aberrations, and often a loss of best-corrected distance visual acuity. Corneal ectasias can result in significant ocular morbidity and may require surgical intervention.

Highlighted findings and recommendations for care include the following:-

• The ophthalmologist needs to measure many aspects of visual function, since best-corrected visual acuity (BCVA) may not completely characterize visual function in these patients.

• Signs of corneal ectasia can include, but are not limited to: inferior steepening, superior flattening, skewing of radial axes on power topographic maps, abnormal islands of elevation anteriorly and/or posteriorly on tomography and decentered or abnormal corneal thinning or rate of change of corneal thickening from the center to the periphery.

• Prior to refractive surgery, corneal topography and tomography performed following a period of contact lens abstinence should be reviewed for evidence of irregular astigmatism or abnormalities suggestive of keratoconus or other forms of corneal ectasia.

• When corneal ectasia occurs following keratorefractive surgery, it is usually determined that the residual stromal bed following surgery was thinner than expected, that the flap was thicker than expected, or that the patient had preoperative signs of subclinical ectasia by tomography.

• It is impossible preoperatively to identify all patients at risk for postkeratorefractive corneal ectasia. Those with risk factors for ectasia may not develop the condition following laser vision correction surgery and some without obvious risk factors may develop ectasia following laser vision correction.

• Corneal cross-linking (CXL) reduces the risk of progressive ectasia in patients with keratoconus (particularly in its early stages) and stabilizes the corneal. It also stabilizes cases of corneal ectasia occurring after keratorefractive surgery.

• Deep anterior lamellar keratoplasty (DALK) may be used to treat ectatic disease. Its advantages include no risk for endothelial rejection and a low risk of stromal rejection. Progressive endothelial cell loss following DALK may also be less than following penetrating keratoplasty.

About AAO
The American Academy of Ophthalmology (Academy) is a professional medical association of ophthalmologists. It is headquartered in San Francisco, California. The Academy's stated mission is "to protect sight and empower lives by serving as an advocate for patients and the public, leading ophthalmic education, and advancing the profession of ophthalmology."

Note: This list is a brief compilation of some of the key recommendations included in the Guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://pxmd.co/ZcSKF and https://pxmd.co/IL3nL
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