Visual outcomes and management after corneal refractive surgery: A review

Abstract

Corneal refractive surgery procedures are widely performed to permanently correct refractive errors. Overall, refractive surgeries are safe, predictable and present high rates of satisfaction. Nevertheless, the induced epithelial, stromal and nerve damage alters corneal integrity and function, triggering a regenerative response. Complications that arise from corneal wound healing process might directly impact on visual outcomes of keratorefractive procedures. Most of these complications can be prevented or effectively treated with minimal consequences and minor impact on optical quality. Nevertheless, it is crucial to accurately and timely identify these corneal regeneration-related complications for successful counseling and management. Optometrists, as primary eye care providers, play an essential role in detecting anatomic and functional alterations in vision. It is therefore of great interest for optometrists to be familiar with the principal postoperative complications derived from alterations in regenerative process after corneal laser refractive surgeries. This review aims to provide a basis for optometrists to better understand, identify and manage the main wound healing-related complications after refractive surgery.

Oral l-Cysteine Supplementation Enhances the Long Term-Effect of Topical Basic Fibroblast Growth Factor (bFGF) in Reducing the Corneal Haze after Photorefractive Keratectomy in Myopic Patients

“…Despite the success of laser refractive surgery to correct low to moderate order aberrations, the incidence of post operative symptoms remains relatively high, reducing the life quality of patients [25]. In fact, discomfort or pain, delayed epithelial healing, loss of best corrected visual acuity, diffuse haze, and unpredictable refractive complications are unavoidable disadvantages associated with refractive surgery [26].…”

“…Corneal stromal wound healing is a very important clinical issue due to great popularity of refractive corneal surgery. It is a very complex and orderly process with keratocyte death and repopulation, sequential transformation of keratocytes into fibroblasts and myofibroblasts, infiltration of limbal and circulating immune cells, and remodeling of the corneal extracellular matrix (ECM) structure [ 25 ]. Moreover, it is of fundamental importance that corneal epithelium and stroma interact during healing [ 3 ].…”

In-vivo 3D corneal elasticity using air-coupled ultrasound optical coherence elastography

“…Moreover, the IOP in ex-vivo corneas is much lower than in-vivo conditions, causing the elastic wave velocity to decrease [17,48,49]. Precise knowledge of corneal biomechanics is critical for early diagnosis, optimal management of diseased corneas (e.g., keratoconus), and predicting the risks of surgical intervention of healthy corneas, such as post-LASIK [3][4][5][6][7][8]. In addition, traditional IOP measurements are often affected by corneal stiffness [9].…”

“…Corneal refractive surgical techniques modify the curvature of the cornea to compensate for refractive errors. At the same time, they also alter the corneal stiffness, which may lead to post-refractive corneal ectasia [4]. Thus, it's suggested that a combination of residual stromal bed thickness with corneal stiffness can be used as a guide for corneal refractive surgery [5].…”

The Wound Healing Responses and Corneal Biomechanics after Keratorefractive Surgery

“…Corneal refractive surgery changes the corneal curvature to correct the refractive error. The most common laser refractive procedures performed today are small incision lenticule extraction surgery (SMILE) [2,3], femtosecond laser in situ keratomileusis (FS-LASIK), and surface ablation procedures, i.e., photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), and epi-LASIK [4]. With the development of the femtosecond laser, the SMILE surgery and FS-LASIK have become the most commonly used procedures in China for myopic subjects.…”