REPLY

摘要

We thank Amoils for his interest in our article and his input into the issue of postoperative ectasia after PRK in patients with early or manifest keratoco-nus. We agree that PRK for manifest keratoconus should not be undertaken without significant patient counseling and that surgery, if performed, should ideally be performed sequentially to assess the safety and efficacy of the procedure for each individual patient. Amoils makes a distinction between central and inferior forms of keratoconus as it pertains to the safety of surface ablation in these patients. The argument for this distinction seems to be based on a theoretically beneficial "hammock-supporting effect" that an inferi-orly intact Bowman's layer could impart on inferior keratectasia. We are wary of this distinction and the biomechanical reasoning behind it.