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)

Abstract

Our purpose is to provide a comprehensive investigation into theincidence, treatment modalities, and visual prognosis ofepithelial-related complications in corneal refractive surgeries,including laser-assisted in situ keratomileusis (LASIK), photorefractivekeratectomy (PRK), and small incision lenticule extraction (SMILE). Asystematic search of multiple databases was conducted by two independentexaminers using various search terms related to epithelial-relatedcomplications and corneal refractive surgeries. A total of 91 researcharticles were included, encompassing a sample size of 66,751 eyes acrossthe three types of surgeries. The average incidence of epithelial-relatedcomplications varied across the different types of corneal refractivesurgeries. 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. Ourfindings indicate that SMILE has a lower incidence of epithelial defectscompared to LASIK, potentially due to the less invasive nature oflenticule incision in SMILE. Visual prognosis after epithelialcomplications (EC) is generally favorable, with various supportive careand surgical interventions leading to significant improvements inpostoperative visual acuity and full recovery. Understanding the incidencerates and management approaches for epithelial-related complications canguide clinicians in enhancing patient safety, refining surgicaltechniques, and optimizing postoperative outcomes in corneal refractivesurgeries. Copyright © 2023, Moshirfar et al.