Purpose: To report a case of post–keratorefractive lenticule extraction (KLEx) ectasia in the United States followed by a comprehensive literature review of all published KLEx ectasia cases with an analysis of risk factors and prevalence rates. Methods: A systematic literature search of PubMed, Embase, Google Scholar, and institutional databases for studies published between January 2008 and April 2026 was conducted. Studies reporting cases of post-KLEx ectasia and large cohort studies with a minimum of 3-year follow-up without ectasia were included. Demographic, tomographic, and surgical parameters were extracted. Comparative statistical analysis between cohorts with and without ectasia was performed. Results: At our institution, a 34-year-old woman developed ectasia 4 years after KLEx, with borderline risk factors and possible subclinical keratoconus. Including this case, 69 eyes from 41 patients across 25 studies were identified with post-KLEx ectasia. Common preoperative abnormalities included elevated Belin/Ambrosio Display Deviation score, reduced Ambrosio Relational Thickness maximum, and tomographic abnormalities. Compared with international nonectatic cohorts, ectatic eyes were significantly younger, had thinner corneas, and higher astigmatism. Overall prevalence of post-KLEx ectasia at our institution was 0.3% over an 8-year period. Conclusions: Post-KLEx ectasia is a rare but recognized complication with several predisposing factors. Younger age, higher astigmatism, and tomographic abnormalities were more prevalent among the ectasia cohort, mirroring established risk factors for post-LASIK and post-PRK ectasia. The development of ectasia even in tomographically normal eyes poses the question of whether refractive surgery induces ectasia de novo or unmasks subclinical keratoconus.

Objectives: To evaluate a general-purpose large language model (LLM)’s ability to perform surgeon-level decision-making in choosing an intraocular lens (IOL) power when provided the same preoperative data. Methods: This study included 293 eyes (174 patients) that underwent monofocal or toric cataract surgery performed by a single surgeon. GPT-5.2 analyzed the same biometric printouts, topographic displays, and preoperative data used in surgical planning. Postoperative refraction for GPT-5.2-selected IOLs was simulated from the measured postoperative refraction using a fixed conversion factor. The mean refractive deviation from target, mean absolute error (MAE), and number of eyes within ±0.25 D and ±0.50 D of target refraction were calculated. A subgroup analysis evaluated toric IOL cylinder magnitude and axis. Results: GPT-5.2-selected IOL power differed significantly from that of the surgeon (19.24 ± 4.01 vs. 19.64 ± 4.07 D [mean ± SD], p < 0.001). Using simulated refractive outcomes for GPT-5.2, MAE was higher than for surgeon-selected IOLs (0.45 ± 0.03 vs. 0.35 ± 0.02 D [mean ± SE], p = 0.002), and a greater percentage of eyes fell within ±0.25 D of target refraction for the surgeon (51.9% vs. 44.7%, p < 0.01), with no difference within ±0.50 D (p = 0.06). In toric eyes, the cylinder magnitude did not differ, but simulated residual astigmatism was higher for GPT-5.2 (0.78 ± 0.55 vs. 0.58 ± 0.47 D, p < 0.001), with an axis flip in 47.1% versus 39.2% of eyes. Conclusions: GPT-5.2 synthesized clinical data and approximated surgeon IOL selection, but its simulated refractive outcomes were less accurate than the surgeon’s measured outcomes. These findings suggest that a domain-specific LLM may serve as a support tool in IOL selection and cataract surgery planning.

Background: Opaque bubble layers (OBLs) are a common intraoperative complication during flap creation in femtosecond laser-assisted LASIK (FS-LASIK). This study aims to evaluate how cone and flap sizes can be optimized to minimize OBL risk in VISUMAX 800 FS-LASIK. Methods: This was a retrospective chart review of patients who underwent LASIK with the VISUMAX 800. Eyes were grouped by cone size and laser settings into S cone/M settings and M cone/L settings, in addition to OBL status (OBL vs. non-OBL). Generalized estimating equations were used to account for inter-eye correlation. Flap–cone edge gap was quantified from intraoperative images using FIJI (version 2.17.0, ImageJ). Results: OBL developed in 17 of 226 eyes (7.5%). The majority of OBLs (15/17) occurred in the M cone with L setting group. Eyes that developed OBLs had larger WTWs (p < 0.001) and larger mean flap diameters (p < 0.001). Among eyes with M cones and L settings, image analysis revealed that the average gap between flap and cone edge was significantly larger in the OBL group (p = 0.007). Conclusions: Our findings support the use of VISUMAX 800 in FS-LASIK and suggest that OBL formation may be associated with the distance between flap and cone edges, with larger average flap–cone gaps observed in eyes that developed OBL.