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 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, PT

Advances in femtosecond laser technology

Thais Pinheiro Callou, Renato Garcia, Adriana Mukai, Natalia T Giacomin, Rodrigo Guimarães de Souza, Samir J Bechara Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil Abstract: Femtosecond laser technology has become widely adopted by ophthalmic surgeons. The purpose of this study is to discuss applications and advantages of femtosecond lasers over traditional manual techniques, and related unique complications in cataract surgery and corneal refractive surgical procedures, including: LASIK flap creation, intracorneal ring segment implantation, presbyopic treatments, keratoplasty, astigmatic keratotomy, and intrastromal lenticule procedures. Keywords: laser therapy, refractive surgical procedures, intracorneal ring, laser in situ keratomileusis, keratoplasty, presbyopia, cataract extraction, astigmatism surger