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Purpose: To determine the prevalence of keratoconus (KC) in relation to ethnicity in N. Macedonia. Methods: This was a cross-sectional, interventional retrospective study. Chart reviews were performed for all new patients attending between January 2016 and January 2020 at the Sistina Ophthalmology Hospital in Skopje. All patients were screened, KC diagnosis and classification was based on the corneal topography. Ethnicity and gender classifications were according to patients’ self-opinions. Results: A total of 2812 patients charts reviewed. The mean age was 31.71 years (SD, ±9.73), 1209 (43%) were male. 2050 (72.9%) declared themselves as Macedonians, 649 (23.1%) Albanians, 76 (2.7%) Turks and 37 (1.3%) in other ethnicities. Differences in age between the ethnic groups was statistically significant (𝑥2=90.225, p<0.001). KC was diagnosed in 343 patients (12.2%), 9 were KC suspects and 6 were pellucid marginal degeneration. KC was more frequent in males (n=246, 71.7% of total) and skewed towards younger patients. Increasing patients’ age decreased the odds of KC diagnosis by 3.7%(95% CI:1.8%-4.4%) per annum. Males were 4 times more likely to be diagnosed with KC (AOR=4.01;95% CI:3.12–5.16). In comparison with Macedonian patients, Turks were more likely to be diagnosed with KC (AOR=4.09;95%CI:2.47–6.78). There was no difference between Macedonians and Albanians (p=0.08). Conclusion: The prevalence of KC at a refractive surgery practice in N.Macedonia is much higher compared with general population and similar to the prevalence in Middle East Asia. Nationwide screening programs are needed to diagnose the disease earlier.

Laser in situ keratomileusis (LASIK) is one of the most commonly performed refractive surgical procedures. During the last two decades, surgical procedure has evolved, but still, there are several intraoperative and postoperative complications possible. Every young LASIK surgeon spends most of the reading time on LASIK complications. They are not frequent, but you have to know precisely what to do when they happen. This chapter should be a guide, based on literature and experience, on how to deal with intraoperative, early postoperative, and late postoperative complications. This chapter will include managing irregular flaps, buttonholes, and free flaps. The treatment scheme for DLK, epithelial ingrowth, and PISK, and when is the time for flap re-lifting. How frequent should be patients’ visits not to miss the complication on time? When is the right time for LASIK reoperation? Post LASIK corneal ectasia and how to perform cross-linking over LASIK. Young surgeons need precise guidelines, not just theoretical treatment options to achieve optimal visual outcomes after LASIK procedure.

Small-incision lenticule extraction (SMILE) is becoming the procedure of choice in treating myopia and myopic astigmatism. With great comparability in terms of visual outcome with the femtosecond laser-assisted in situ keratomileusis (FsLASIK) procedure, the method is characterized by better patient satisfaction and less postoperative dry eye induction. Moreover, it has the advantages of better eye surface stability and biomechanical strength compared to FS-LASIK. The method is now globally accepted among refractive surgeons. Patients suitable for the procedure must meet criteria for keratorefractive procedures generally. Our current clinical experience suggests that the lenticule extraction procedure delivers promising refractive results in terms of predictability, efficacy, and safety.