Iatrogenic Keratectasia after Refractive Surgery - Causes, Prophylaxis, Therapy

Area of Science:

• Ophthalmology
• Corneal Surgery
• Refractive Surgery Outcomes

Background:

• Iatrogenic keratectasia is cornea thinning and protrusion post-laser refractive surgery.
• Risk factors include thin residual stromal bed, thick flaps, or subclinical keratoconus.
• The incidence varies by procedure: PRK (20/100K), LASIK (90/100K), SMILE (11/100K) in eyes without identified risks.

Purpose of the Study:

• To review the incidence, risk factors, screening methods, and treatments for iatrogenic keratectasia.
• To highlight the occurrence of ectasia even in the absence of preoperative risk factors.
• To discuss advancements in diagnostic and therapeutic approaches.

Main Methods:

• Literature review of iatrogenic keratectasia post-laser refractive surgery.
• Analysis of incidence rates across different refractive procedures.
• Examination of traditional and novel screening techniques.
• Overview of current and emerging therapeutic interventions.

Main Results:

• Iatrogenic keratectasia occurs at varying rates, with LASIK showing a higher incidence compared to PRK and SMILE.
• Preoperative risk factors are not always present, indicating a need for comprehensive screening.
• Advanced methods like corneal elastography, epithelial mapping, and AI are emerging for risk assessment.
• Treatment options range from conservative management to surgical interventions like keratoplasty.

Conclusions:

• Iatrogenic keratectasia remains a potential complication of laser refractive surgery, necessitating vigilant preoperative screening.
• The development of new diagnostic tools and therapeutic strategies is vital for improving patient outcomes.
• Further research into AI and advanced imaging may enhance the prediction and management of post-refractive surgery ectasia.