Theoretical elastic response of the cornea to refractive surgery: risk factors for keratectasia

To explore the role that mechanical elastic factors may have in post-refractive surgery corneal phenomena, from mild curvature changes to keratectasia.

The central cornea near the apex was modeled as an elastic spherical thin shell loaded by the intraocular pressure (IOP). Equations for myopic laser in situ keratomileusis (LASIK) were obtained to estimate shifts and curvature changes of the posterior corneal surface at the apex. The effect of every parameter was studied, identifying potential risk factors for ectasia.

Theoretically, corneal thinning by ablation will produce an elastic deformation of the posterior surface that depends on the corneal parameters (curvature, Young's modulus, Poisson ratio, and thickness), the IOP, and the ablation profile. In particular, a forward shift and an increase in power of the posterior surface was predicted for myopic LASIK, in agreement with previous experimental findings. These changes rise non-linearly with the attempted correction, and are greater for thinner preoperative corneas, higher IOP smaller Young's modulus, and thicker flaps. Corneas with Young's modulus half the average or less, or thickness <500 microm, may present high risk of ectasia, especially for high IOP and thick flaps.

Some postoperative effects may be explained in part by elasticity. Research efforts are needed to explain other biomechanical behaviors. The accepted criterion of 250 microm residual bed is insufficient for fine patient screening--depending on the individual ocular parameters, it could be more restrictive. Advances in technology are needed to create a preoperative examination including two-dimensional maps of topography, pachymetry, and Young's modulus.