Preoperative Assessment for Risk Management in Corneal Refractive Surgery

s with all types of surgery, corneal refractive procedures are associated with a risk of complications. While these risks are very low, they can vary widely from one patient to another based on preoperative characteristics, the type of refractive surgery and postoperative management. One of the rarer, but more serious, complications of corneal refractive procedures is corneal ectasia or keratectasia. Ectasia progression is linked to the impact of the procedure on the cornea and with the preoperative corneal structure. The presence of mild (subclinical) keratoconus, also referred to as forme fruste keratoconus, is recognised as the most critical risk factor. However, the evolution of corneal imaging using a multimodal approach, including 3D corneal tomography and biomechanical assessment, enables the characterisation of corneal susceptibility for ectasia progression during the presurgical assessment. This enhanced approach also allows the surgeon to augment the efficiency of the procedure, selecting the most appropriate surgical method for optimising the chance of success and preventing complications.