Late-onset unilateral corneal ectasia after PRK with mitomycin-C: case report in a low-risk patient

Introduction: This case describes a rare instance of unilateral corneal ectasia developing 3 years after photorefractive keratectomy (PRK) with intraoperative mitomycin-C, in a patient who had low-risk factors. It raises questions about the presumed safety of PRK in low-risk eyes. Patient and Clinical Findings: A 32-year-old man presented with progressive visual decline in the right eye, 3 years after bilateral PRK. Preoperative evaluations, including topography tests, were unremarkable. The left eye remained stable during follow-up. Diagnosis, Intervention, and Outcomes: The diagnosis of unilateral ectasia was made. Treatment included corneal cross-linking and implantation of an asymmetric intracorneal ring segment, resulting in improved corrected distance visual acuity (20/25) and no further progression of ectasia. Conclusions: Ectasia may develop even in cases considered low risk for biomechanical failure. This report highlights the importance of extended postoperative follow-up and illustrates the limitations of current screening tools in detecting susceptibility to late-onset ectasia.