Characteristics Of Ectasia After Corneal Refractive Surgery In Central China

To analyze the demographic and clinical characteristics of the population with corneal ectasia following refractive surgery in Central China.

Wuhan Aier Hankou Eye Hospital, Wuhan University, Wuhan, China.

The demographic and clinical data of patients with corneal ectasia following refractive surgery who were treated at Wuhan Aier Hankou Eye Hospital from August 2014 to December 2023 were analyzed. Age, gender, family history, past medical and ocular history, time of visual acuity decrease after refractive surgery, time of diagnosis of corneal ectasia, and after diagnosis examination including uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), slit-lamp microscopic examination, intraocular pressure, axial length, and corneal topography data. The severity of ectasia after corneal refractive surgery was classified using the Amsler-Krumeich classification.

27 patients (44 eyes) were enrolled with 19 males and 8 females. 23 patients (37 eyes) had a history of LASIK, 2 patients (3 eyes) of SMILE, 1 patient (2 eye) of LASIK Xtra, and 1 patient (2 eyes) of PRK. The average age of refractive surgery was 20.78 ± 3.73 years. Visual acuity began to decline 1 to 156 (average 65.59 ± 47.88) months after refractive surgery. The time interval from the onset of blurred vision  to the diagnosis of ectasia was 0.1 to 168 (average 31.11 ± 38.23) months . 12 patients（44.4%） reported a history of rubbing eyes. According to the AK classification, stage 1 accounted for 20 eyes (45.5%). 35 eyes were treated with Epi-on CXL,  Kmax, BCVA remained stable while UCVA improved significantly (P=0.02)  postoperatively.

Postrefractive ectasia occurs at higher rates in eyes undergoing LASIK than PRK and SMILE, even in eyes with LASIK combined with prophylactic CXL. Males, younger than 21yrs and rubbing eyes seemed to be risk factors. The prolonged interval between refractive surgery and visual acuity decline and interval between visual acuity decline and diagnosis of ectasia reveals the importance of long-term follow-up after refractive surgery and patient education. Transepithelial CXL is an effective and safe treatment for postrefractive ectasia.