Recurrent Corneal Erosion following Uneventful IntraLASIK Treated by Phototherapeutic Keratectomy

A Literature Review of the Incidence, Management, and Prognosis of Corneal Epithelial-Related Complications After Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK), and Small Incision Lenticule Extraction (SMILE)

Our purpose is to provide a comprehensive investigation into the incidence, treatment modalities, and visual prognosis of epithelial-related complications in corneal refractive surgeries, including laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE). A systematic search of multiple databases was conducted by two independent examiners using various search terms related to epithelial-related complications and corneal refractive surgeries. A total of 91 research articles were included, encompassing a sample size of 66,751 eyes across the three types of surgeries. The average incidence of epithelial-related complications varied across the different types of corneal refractive surgeries. LASIK had an average incidence of 4.9% for epithelial defects, while PRK and SMILE had lower rates of 3.3% and 3.9%, respectively. Our findings indicate that SMILE has a lower incidence of epithelial defects compared to LASIK, potentially due to the less invasive nature of lenticule incision in SMILE. Visual prognosis after epithelial complications (EC) is generally favorable, with various supportive care and surgical interventions leading to significant improvements in postoperative visual acuity and full recovery. Understanding the incidence rates and management approaches for epithelial-related complications can guide clinicians in enhancing patient safety, refining surgical techniques, and optimizing postoperative outcomes in corneal refractive surgeries.

Clinical presentation and causes of recurrent corneal erosion syndrome: review of 100 patients

PURPOSE

To study the clinical features and etiology of recurrent corneal erosion syndrome (RCES).

METHODS

We examined a total of 100 patients (117 eyes) with the diagnosis of RCES who presented at our institution (Instituto Clinico Quirúrgico de Oftalmología, Bilbao, Spain). Studied data included demography, etiology, corneal location, and association with meibomian gland dysfunction (MGD).

RESULTS

The mean age of patients was 44.5 (range, 14-80) years. Attributed causes of RCES were previous minor trauma (46 eyes, 39.3%), epithelial basement membrane corneal dystrophy (20 eyes, 17.1%), photorefractive keratectomy (20 eyes, 17.1%), laser-assisted in situ keratomileusis (9 eyes, 7.7%), and of unknown origin (22 eyes, 18.8%). The most frequent site of RCES was the inferior paracentral cornea (68.4%), followed by the upper cornea (21.3%) and widespread location (21.3%). An association with MGD was found in 59% of patients.

CONCLUSIONS

RCES has various etiologies, which explains the variety in the clinical presentation of the disorder. Interestingly, a significant number of RCES patients begin to manifest the syndrome after keratorefractive surgery, and a high percentage of patients also present with MGD.