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COMMENTARY
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1032

Commentary: Ectasia after keratorefractive surgery: An ounce of prevention is worth a pound of cure


Cornea, Refractive and Ocular Surface Services, L.J. Eye Institute, Ambala, Haryana, India

Date of Web Publication25-May-2020

Correspondence Address:
Dr. Purvasha Narang
Cornea, Refractive and Ocular Surface Services, L.J. Eye Institute, Ambala, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2385_19

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How to cite this article:
Narang P. Commentary: Ectasia after keratorefractive surgery: An ounce of prevention is worth a pound of cure. Indian J Ophthalmol 2020;68:1032

How to cite this URL:
Narang P. Commentary: Ectasia after keratorefractive surgery: An ounce of prevention is worth a pound of cure. Indian J Ophthalmol [serial online] 2020 [cited 2024 Mar 29];68:1032. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2020/68/6/1032/284839



Ectasia after LASER vision correction (LVC) procedure is a rare complication leading to loss of best-corrected visual acuity (BCVA) due to progressive thinning and steepening of the cornea. This can be a nightmare for both the patient as well as the surgeon.

The various risk factors that have been studied are: younger age, high manifest refraction spherical equivalent (more ablation depth), a thin cornea (lesser than 500 μm), anterior topographic irregularities, high posterior elevation float (>15 μm at the thinnest point), an Ectasia Risk Score higher than 3, low residual stromal bed thickness (RSB), high percent tissue thickness alteration (PTA), etc.[1],[2],[3]

As the burden of disease is more in young adults, every effort should be made to prevent the occurrence of ectasia by conscientiously looking at the risk factors in each eye prior to performing keratorefractive surgery. With the evolution of our understanding of the disease over the years, major attempts have been made to develop advanced screening strategies. As a result, the actual incidence of ectasia has decreased from the relatively high level of 0.66% reported by Pallikaris in 2001,[4] down to 0.033% in 2018.[5]

An “ideal” prevention strategy would be an individualized enhanced ectasia screening model integrating objective data that assesses corneal structure and biomechanical impact from the procedure as well as the long-term stresses on the cornea due to eye rubbing, intraocular pressure (IOP), extraocular muscles actions, eyelid blinking,[6] and possibly hormonal influences.

Artificial intelligence (AI) and pattern recognition algorithms have been developed [7] to have a significant role in screening ectasia, e.g., Tomographic and Biomechanical Index (TBI),[8] the Pentacam Random Forest Index (PRFI),[9] and the recent Ectasia Susceptibility Score (ESS).[10] For developing such algorithms, it is necessary to have clinical data to train and validate the AI models in different populations.

In the current study,[11] ectasia was found to occur in 40 eyes after performing LASIK (Microkeratome and Femto-second), PRK, and SMILE. It was bilateral in more than 53% cases. The 8 eyes with no identifiable risk factors may be re-evaluated and pertinent clinical history of eye rubbing or allergy or hormonal imbalance may be included to make the study more useful, as these factors are now being considered as possible risks. Inclusion of such parameters might help in creating a more supportive database in Indian eyes for the development of more accurate Ectasia prediction tools and, hence, avoidance of LVC in susceptible eyes.

Acknowledgements

Vikas Mittal, L.J. Eye Institute, Ambala, India 134003.



 
  References Top

1.
Randleman JB, Russell B, Ward MA, Thompson KP, Stulting RD. Risk factors and prognosis for corneal ectasia after LASIK. Ophthalmology 2003;110:267-75.  Back to cited text no. 1
    
2.
Rad AS, Jabbarvand M, Saifi N. Progressive keratectasia after laser in situ keratomileusis. J Refract Surg 2004;20:S718-22.  Back to cited text no. 2
    
3.
Miraftab M, Fotouhi A, Hashemi H, Jafari F, Shahnazi A, Asgari S. A modified risk assessment scoring system for post laser in situ keratomileusis ectasia in topographically normal patients. J Ophthalmic Vis Res 2014;9:434-8.  Back to cited text no. 3
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4.
Pallikaris IG, Kymionis GD, Astyrakakis NI. Corneal ectasia induced by laser in situ keratomileusis. J Cataract Refract Surg 2001;27:1796-802.  Back to cited text no. 4
    
5.
Bohac M, Koncarevic M, Pasalic A, Biscevic A, Merlak M, Gabric N, et al. Incidence and clinical characteristics of post LASIK Ectasia: A review of over 30,000 LASIK cases. Semin Ophthalmol 2018;33:869-77.  Back to cited text no. 5
    
6.
Ambrósio R. Post-LASIK ectasia: Twenty years of a conundrum. Semin Ophthalmol 2019;34:66-8.  Back to cited text no. 6
    
7.
Klyce SD. The future of keratoconus screening with artificial intelligence. Ophthalmology 2018;125:1872-3.  Back to cited text no. 7
    
8.
Ambrósio R Jr, Lopes BT, Faria-Correia F, Salomão MQ, Bühren J, Roberts CJ, et al. Integration of scheimpflug-based corneal tomography and biomechanical assessments for enhancing Ectasia detection. J Refract Surg 2017;33:434-43.  Back to cited text no. 8
    
9.
Lopes BT, Ramos IC, Salomao MQ, Guerra FP, Schallhorn SC, Schallhorn JM, et al. Enhanced tomographic assessment to detect corneal Ectasia based on artificial intelligence. Am J Ophthalmol 2018;195:223-32.  Back to cited text no. 9
    
10.
Ambrósio R Jr, Belin M. Enhanced screening for Ectasia risk prior to laser vision correction. Int J Keratoconus Ectatic Corneal Dis 2017;6:23-33.  Back to cited text no. 10
    
11.
Soundarya B, Sachdev GS, Ramamurthy S, Dandapani R. Ectasia after keratorefractive surgery: Analysis of risk factors and treatment outcomes in the Indian population. Indian J Ophthalmol 2020;68:1028-31.  Back to cited text no. 11
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