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

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.

Automated summary

Post-laser in situ keratomileusis (post-LASIK) ectasia (PLE) is a serious complication of refractive surgery, characterized by progressive thinning and trembling thinning of the cornea, along with increased myopia and astigmatism. The main causes include genetic risk factors and external environmental factors such as eye rubbing and cornea surgery. The use of artificial intelligence and high-fidelity finite element modeling can aid in improving preoperative screening and predicting the risk of postoperative ectasia. This comprehensive review focuses on the incidence, etiology, prevention, and treatment of PLE, emphasizing the importance of understanding factors involved in delaying the onset and slowing progression of cornea ectasia.