Diagnosis and management of postrefractive surgery ectasia

Hatch, Kathryn M; Ling, Joseph; Wiley, William F.; Cason, John B.; Ciralsky, Jessica; Nehls, Sarah; McCabe, Cathleen M.; Donnenfeld, Eric D.; Thompson, Vance

doi:10.1097/j.jcrs.0000000000000808

Cited by 6 publications

(13 citation statements)

References 67 publications

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“…It is helpful to measure and track the BCVA since a reduction might signify increasing irregular astigmatism and possibly a more serious situation (Padmanabhan et al, 2016). Corneal tomography can help the examiner understand if there is the central steepening and irregularity consistent with worsening ectasia (Hatch et al, 2021). Therefore, we should control the stability of IOP in the early stage after LASIK, actively deal with dry and irritated eyes, and remind patients of regular review after surgery.…”

Section: Postoperationmentioning

confidence: 99%

Comprehensive management of post‐LASIK ectasia: From prevention to treatment

Zhao

Yin

et al. 2023

Acta Ophthalmologica

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Post‐laser in situ keratomileusis (post‐LASIK) ectasia (PLE) is one of the most serious complications after refractive surgery, mainly manifested as progressive thinning and trembling thinning of the cornea, accompanied by increased myopia and astigmatism. The mechanisms behind mainly include genetic risk factors and external environmental factors such as eye rubbing and cornea surgery. In order to achieve the goal of reducing the incidence of ectasia, preoperative screening strategies need to be continuously improved, through the collection and assessment of genetic and environmental risk factors. Although previous preoperative screening methods did not have a uniform standard, the emergence of artificial intelligence (AI) can help us process a large amount of information and make rational use of the data. By using high‐fidelity finite element modelling, differences in preoperative and postoperative strain distributions can be observed, which can predict the risk of postoperative ectasia. In this review, we describe the incidence, aetiology, prevention and treatment of PLE for the purpose of comprehensive management. In terms of treatment, corneal collagen cross‐linking has been widely used to treat progressive keratoconus and other ectasia disease, either as a preventive measure during surgery or as a therapeutic modality after surgery to prevent progression of corneal dilation. Although the standard Dresden protocol has been identified as the gold standard treatment for corneal dilatation, a series of refinements, investigations and long‐term studies have been conducted in recent years. Thus, understanding the factors involved in delaying the onset and slowing progression of cornea ectasia will be key to reducing the incidence worldwide.

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Section: Postoperationmentioning

confidence: 99%

Comprehensive management of post‐LASIK ectasia: From prevention to treatment

Zhao

Yin

et al. 2023

Acta Ophthalmologica

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“…Corneal ectasia (CE) develops when the cornea becomes weakened or stretched, thins and bulges outward, distorting the shape and vision. It can be caused by trauma, keratoconus (KC), excessive pressure from contact lenses, intracorneal ring segments (ICRS) or autoimmune diseases [1 ▪ ]. Atopy and allergies have been associated with ectasia formation.…”

Section: Introductionmentioning

confidence: 99%

“…Atopy and allergies have been associated with ectasia formation. CE is one of the most severe complications following refractive surgeries and can result in irreversible loss of best-corrected visual acuity, blurred vision, monocular diplopia or light sensitivity, irregular astigmatism, corneal scarring and opacification, and potentially perforation [1 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

Ocular surface inflammation and ectatic corneal disorders

Erdinest

Wajnsztajn

London

et al. 2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review Inflammatory mediators are a focus of recent corneal ectasia (CE) research and are a profound, modifiable contributor to CE in general and keratoconus (KC) in particular, opening a path to explore new methods of control. As advanced imaging technology and expanded population screening allow for earlier detection, the possibility of early intervention can profoundly change the prognosis of CE. Recent findings Significant increases in the inflammatory mediators and immune components have been observed in the cornea, tear fluid, and blood of ectasia patients, while inflammation dampeners such as vitamin D and their receptors are reduced. Atopy and allergy have a strong association with KC, known to increase itch factors and stimulate eye rubbing, a risk factor in ectasia pathogenesis. Management of atopy or allergic conditions and topical anti-inflammatories has helped stabilize CE disease. Summary Strategies such as monitoring inflammatory factors and using immune or inflammatory modulators, including managing subclinical inflammation, may be clinically beneficial in stabilizing the disease and improving outcomes. The detected factors are biomarkers, but as yet unproven to be sensitive or specific enough to be considered biomarkers for early detection of CE. The establishment of such biomarkers could improve the therapeutic outcome.

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Comment on: Diagnosis and management of postrefractive surgery ectasia A review summarizing the diagnostic approaches and surgical treatment options for postoperative ectasia (POE) was recently published by Hatch et al 1 The article includes key corneal crosslinking (CXL) references, but a published CXL technique termed under-flap CXL (ufCXL) was not discussed. 2 The current correspondence, therefore, aims to bring further updates to the POE literature.The innovative ufCXL procedure is performed under a previous laser in situ keratomileusis (LASIK) flap for early POE.

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mentioning

confidence: 99%

“…A review summarizing the diagnostic approaches and surgical treatment options for postoperative ectasia (POE) was recently published by Hatch et al 1 The article includes key corneal crosslinking (CXL) references, but a published CXL technique termed under-flap CXL (ufCXL) was not discussed. 2 The current correspondence, therefore, aims to bring further updates to the POE literature.…”

mentioning

confidence: 99%