Refractive Surgery and Refractive Regression: Mechanisms and Mitigation Strategies

• DOI: https://doi.org/10.22533/at.ed.1594932415103

• Palavras-chave: Refractive surgery; Corneal biomechanics; Refractive regression; LASIK enhancement; Epithelial hyperplasia.

• Keywords: Refractive surgery; Corneal biomechanics; Refractive regression; LASIK enhancement; Epithelial hyperplasia.

• Abstract: INTRODUCTION The introduction outlines the prevalence and significance of refractive surgery in correcting refractive errors such as myopia, hyperopia, and astigmatism. It addresses refractive regression as a recurrent issue that undermines long-term outcomes. The introduction highlights the importance of corneal biomechanics, epithelial healing, and patient factors in influencing the likelihood of regression. Advances in surgical techniques and the need for effective prevention strategies are introduced as central themes of the review. OBJETIVE To comprehensively review the causes and mechanisms of refractive regression following refractive surgery, with a focus on LASIK, PRK, and SMILE, and to evaluate the strategies for preventing or managing this phenomenon. METHODS This is a narrative review which included studies in the MEDLINE – PubMed (National Library of Medicine, National Institutes of Health), COCHRANE, EMBASE and Google Scholar databases, using as descriptors: “Refractive surgery” AND “Refractive regression” OR “Corneal biomechanics” AND “LASIK and SMILE outcomes” OR “Postoperative stability” in the last  years. RESULTS AND DISCUSSION The results and discussion sections focus on the multifactorial nature of refractive regression, emphasizing corneal biomechanical changes and epithelial hyperplasia as key contributors. Patient-specific factors, such as age, hormonal status, and systemic conditions, are analyzed for their influence on postoperative outcomes. The discussion evaluates the impact of different refractive techniques, such as LASIK, PRK, and SMILE, on regression rates and explores the potential of corneal cross-linking and other emerging technologies in enhancing corneal stability. The role of postoperative care and enhancement procedures in managing regression is also discussed in depth. CONCLUSION The conclusion underscores that refractive regression, though a persistent challenge, is increasingly being addressed through advancements in surgical techniques, individualized patient assessments, and novel postoperative strategies. Continued research and the development of new technologies, including biomechanically-modulated treatments and pharmacologic interventions, are key to improving long-term outcomes in refractive surgery. The conclusion reiterates the importance of patient education and compliance in minimizing regression and maintaining stable refractive results.