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Ectasia risk factors in refractive surgery

Marcony R Santhiago,1 Natalia T Giacomin,1 David Smadja,2 Samir J Bechara1 1Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil, 2Ophthalmology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Abstract: This review outlines risk facto...

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Autores principales:	Santhiago MR, Giacomin NT, Smadja D, Bechara SJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	ectasia risk factor refractive surgery Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/b62071171479489fb0d693e1eb227baa
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spelling	oai:doaj.org-article:b62071171479489fb0d693e1eb227baa2021-12-02T02:45:24ZEctasia risk factors in refractive surgery1177-5483https://doaj.org/article/b62071171479489fb0d693e1eb227baa2016-04-01T00:00:00Zhttps://www.dovepress.com/ectasia-risk-factors-in-refractive-surgery-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Marcony R Santhiago,1 Natalia T Giacomin,1 David Smadja,2 Samir J Bechara1 1Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil, 2Ophthalmology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Abstract: This review outlines risk factors of post-laser in situ keratomileusis (LASIK) ectasia that can be detected preoperatively and presents a new metric to be considered in the detection of ectasia risk. Relevant factors in refractive surgery screening include the analysis of intrinsic biomechanical properties (information obtained from corneal topography/tomography and patient’s age), as well as the analysis of alterable biomechanical properties (information obtained from the amount of tissue altered by surgery and the remaining load-bearing tissue). Corneal topography patterns of placido disk seem to play a pivotal role as a surrogate of corneal strength, and abnormal corneal topography remains to be the most important identifiable risk factor for ectasia. Information derived from tomography, such as pachymetric and epithelial maps as well as computational strategies, to help in the detection of keratoconus is additional and relevant. High percentage of tissue altered (PTA) is the most robust risk factor for ectasia after LASIK in patients with normal preoperative corneal topography. Compared to specific residual stromal bed (RSB) or central corneal thickness values, percentage of tissue altered likely provides a more individualized measure of biomechanical alteration because it considers the relationship between thickness, tissue altered through ablation and flap creation, and ultimate RSB thickness. Other recognized risk factors include low RSB, thin cornea, and high myopia. Age is also a very important risk factor and still remains as one of the most overlooked ones. A comprehensive screening approach with the Ectasia Risk Score System, which evaluates multiple risk factors simultaneously, is also a helpful tool in the screening strategy. Keywords: ectasia, risk factor, refractive surgery, PTASanthiago MRGiacomin NTSmadja DBechara SJDove Medical Pressarticleectasiarisk factorrefractive surgeryOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2016, Iss Issue 1, Pp 713-720 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	ectasia risk factor refractive surgery Ophthalmology RE1-994
spellingShingle	ectasia risk factor refractive surgery Ophthalmology RE1-994 Santhiago MR Giacomin NT Smadja D Bechara SJ Ectasia risk factors in refractive surgery
description	Marcony R Santhiago,1 Natalia T Giacomin,1 David Smadja,2 Samir J Bechara1 1Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil, 2Ophthalmology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Abstract: This review outlines risk factors of post-laser in situ keratomileusis (LASIK) ectasia that can be detected preoperatively and presents a new metric to be considered in the detection of ectasia risk. Relevant factors in refractive surgery screening include the analysis of intrinsic biomechanical properties (information obtained from corneal topography/tomography and patient’s age), as well as the analysis of alterable biomechanical properties (information obtained from the amount of tissue altered by surgery and the remaining load-bearing tissue). Corneal topography patterns of placido disk seem to play a pivotal role as a surrogate of corneal strength, and abnormal corneal topography remains to be the most important identifiable risk factor for ectasia. Information derived from tomography, such as pachymetric and epithelial maps as well as computational strategies, to help in the detection of keratoconus is additional and relevant. High percentage of tissue altered (PTA) is the most robust risk factor for ectasia after LASIK in patients with normal preoperative corneal topography. Compared to specific residual stromal bed (RSB) or central corneal thickness values, percentage of tissue altered likely provides a more individualized measure of biomechanical alteration because it considers the relationship between thickness, tissue altered through ablation and flap creation, and ultimate RSB thickness. Other recognized risk factors include low RSB, thin cornea, and high myopia. Age is also a very important risk factor and still remains as one of the most overlooked ones. A comprehensive screening approach with the Ectasia Risk Score System, which evaluates multiple risk factors simultaneously, is also a helpful tool in the screening strategy. Keywords: ectasia, risk factor, refractive surgery, PTA
format	article
author	Santhiago MR Giacomin NT Smadja D Bechara SJ
author_facet	Santhiago MR Giacomin NT Smadja D Bechara SJ
author_sort	Santhiago MR
title	Ectasia risk factors in refractive surgery
title_short	Ectasia risk factors in refractive surgery
title_full	Ectasia risk factors in refractive surgery
title_fullStr	Ectasia risk factors in refractive surgery
title_full_unstemmed	Ectasia risk factors in refractive surgery
title_sort	ectasia risk factors in refractive surgery
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/b62071171479489fb0d693e1eb227baa
work_keys_str_mv	AT santhiagomr ectasiariskfactorsinrefractivesurgery AT giacominnt ectasiariskfactorsinrefractivesurgery AT smadjad ectasiariskfactorsinrefractivesurgery AT becharasj ectasiariskfactorsinrefractivesurgery
_version_	1718402185312600064

Ectasia risk factors in refractive surgery

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