000153009 001__ 153009
000153009 005__ 20250403160453.0
000153009 0247_ $$2doi$$a10.3389/fbioe.2025.1548539
000153009 0248_ $$2sideral$$a143467
000153009 037__ $$aART-2025-143467
000153009 041__ $$aeng
000153009 100__ $$aFantaci, Benedetta$$uUniversidad de Zaragoza
000153009 245__ $$aUnraveling the impact of laser refractive surgery on corneal ectasia: an in silico study
000153009 260__ $$c2025
000153009 5060_ $$aAccess copy available to the general public$$fUnrestricted
000153009 5203_ $$aIntroductionLaser refractive surgeries are a safe option for low-to-moderate refractive corrections, providing excellent visual outcomes. Over the years, various procedures have been introduced into clinical practice, but the most performed today remain Photorefractive Keratectomy (PRK), Laser In-Situ Keratomileusis (LASIK), and Small Incision Lenticule Extraction (SMILE). Although laser refractive treatments are considered safe, clinicians have focused on the risk of post-surgical ectasia, a rare but serious complication. Ectasia is characterized by progressive corneal thinning and steepening, leading to vision distortion, irregular astigmatism, and in some cases, a reduction of visual acuity. It is still debated whether laser refractive surgeries can cause ectasia as an iatrogenic condition or merely accelerate the progression of an underlying corneal pathology, not detected during pre-surgical screening. The proposed work investigates the relationship among three laser refractive surgeries (PRK, LASIK and SMILE), currently performed in clinical practice, and ectasia onset and progression by means of an in silico analysis.MethodsAn average 3D finite-element corneal model is developed and a pathological area, characterized by reduced stiffness of varying severity grades, is defined to analyze its influence on ectasia development and progression in the pre-surgical state. Three laser treatments (PRK, LASIK and SMILE) are simulated on healthy and pathological models. Pre- and post-surgical conditions are compared to check whether any procedure worsens the pre-surgical pathological state. The optomechanical effect of each procedure on the cornea is analyzed at both healthy and pathological conditions and compared to establish which refractive procedure mostly affects corneal structure.Results and discussionWhile the three refractive procedures showed different behaviors in terms of mechanical changes affecting the cornea, from an optical perspective, as the pathology severity worsened, none of the surgeries caused a worsening in the cone’s severity with respect to pre-surgical pathological conditions. This result suggests that surgeries may have a limited role in causing post-surgical ectasia, as it seems more plausible that they accelerate the progression of an underlying pathological condition. Among the three procedures, PRK was found to be the least invasive treatment from a mechanical perspective, while SMILE showed the greatest impact on the posterior surface, suggesting a potential long-term risk for ectasia progression.
000153009 536__ $$9info:eu-repo/grantAgreement/ES/DGA/T24-23R$$9info:eu-repo/grantAgreement/EC/H2020/956720/EU/Opto-Biomechanical Eye Research Network/OBERON$$9This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No H2020 956720-OBERON$$9info:eu-repo/grantAgreement/ES/UZ/ICTS NANBIOSIS-CIBER-BBN
000153009 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000153009 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000153009 700__ $$0(orcid)0000-0001-7612-266X$$aRodriguez Matas, José Félix
000153009 700__ $$aSquartecchia, Vittoria
000153009 700__ $$aVavassori, Lucia
000153009 700__ $$0(orcid)0000-0001-9713-1813$$aCalvo, Begoña$$uUniversidad de Zaragoza
000153009 7102_ $$15004$$2605$$aUniversidad de Zaragoza$$bDpto. Ingeniería Mecánica$$cÁrea Mec.Med.Cont. y Teor.Est.
000153009 773__ $$g13 (2025), 1548539 [16 pp.]$$pFront. Bioeng. Biotechnol.$$tFrontiers in Bioengineering and Biotechnology$$x2296-4185
000153009 8564_ $$s3573117$$uhttps://zaguan.unizar.es/record/153009/files/texto_completo.pdf$$yVersión publicada
000153009 8564_ $$s2134983$$uhttps://zaguan.unizar.es/record/153009/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000153009 909CO $$ooai:zaguan.unizar.es:153009$$particulos$$pdriver
000153009 951__ $$a2025-04-03-14:37:44
000153009 980__ $$aARTICLE