National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Eye Center of Xiangya Hospital, Hunan Key Laboratory of Ophthalmology, Xiangya Hospital, Central South University, Changsha, China.
Acta Ophthalmol. 2023 Aug;101(5):485-503. doi: 10.1111/aos.15636. Epub 2023 Feb 12.
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.
激光原位角膜磨镶术后（LASIK 术后）扩张（PLE）是屈光手术后最严重的并发症之一，主要表现为角膜进行性变薄和震颤性变薄，伴有近视和散光增加。其主要机制包括遗传风险因素和外部环境因素，如眼揉和角膜手术。为了达到减少扩张发生率的目标，需要不断改进术前筛查策略，通过收集和评估遗传和环境风险因素。虽然以前的术前筛查方法没有统一的标准，但人工智能（AI）的出现可以帮助我们处理大量信息并合理利用数据。通过使用高保真有限元建模，可以观察到术前和术后应变分布的差异，从而预测术后扩张的风险。在这篇综述中，我们描述了 PLE 的发病率、病因、预防和治疗，旨在进行全面管理。在治疗方面，角膜胶原交联已广泛用于治疗进行性圆锥角膜和其他扩张性疾病，无论是作为手术期间的预防措施还是作为手术后的治疗方式，以防止角膜扩张的进展。尽管已经确定德累斯顿标准方案是角膜扩张的金标准治疗方法，但近年来已经进行了一系列的改进、研究和长期研究。因此，了解延迟角膜扩张发病和减缓扩张进展的因素将是降低全球发病率的关键。
