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Klin Monbl Augenheilkd 2023; 240(06): 783-794
DOI: 10.1055/a-2073-8478
DOI: 10.1055/a-2073-8478
Übersicht/Review
Iatrogenic Keratectasia after Refractive Surgery – Causes, Prophylaxis, Therapy
Article in several languages: deutsch | English
Abstract
Iatrogenic keratectasia is induced thinning and protrusion of the cornea after laser refractive surgery. Known risk factors include an excessively thin postoperative residual stromal bed, a thicker flap, or preoperatively undetected evidence of preexisting subclinical keratoconus. The rate of post-refractive ectasia in eyes without identifiable preoperative risk factors is 20 per 100 000 eyes for photorefractive keratectomy, 90 per 100 000 eyes for laser in situ keratomileusis, and 11 per 100 000 eyes for small incision lenticule extraction. Traditional screening tools for preoperative risk include the ectasia risk score system and percentage of tissue alteration. More recent methods include corneal elastography and epithelial mapping, in addition to Artificial Intelligence methods for data analysis. Therapy includes contact lenses, cross-linking, implantation of intracorneal ring segments, penetrating or lamellar keratoplasty, and, in early studies, implantation of corneal lenticules.
Publication History
Received: 27 November 2022
Accepted: 05 April 2023
Article published online:
22 June 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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