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Could the percent tissue altered (PTA) index be considered as a unique factor in ectasia risk assessment?

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To evaluate the efficacy, safety, predictability and stability of the percent tissue altered (PTA) formula in post-LASIK (laser-assisted in situ keratomileusis) ectasia risk assessment.


One hundred and ninety-three eyes from 104 patients with low to moderate myopia that underwent femtosecond LASIK were included in this retrospective, observational and longitudinal study. Seventy-eight eyes were classified in the higher-PTA (> 40%) group and 115 eyes in the lower-PTA (< 40%) group. Spherical manifest refraction, cylinder manifest refraction, logMAR and Snellen previous corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), anterior face Baiocchi Calossi Versaci index (BCVf) and posterior face (BCVb), central corneal thickness (CCT), estimated residual stromal bed (RSB), spherical aberration (SA) and root mean square (RMS) were reported. All patients were followed up for 4 years.


In the higher-PTA group, 97% of eyes reported UDVA 20/20 or better, and in the lower-PTA group, all eyes achieved 20/20 or better. No group reported decreased visual acuity. The higher-PTA group obtained 55% of eyes within ± 0.50 D and 90% within ± 1.00 D; and the lower-PTA group obtained 63% of eyes within ± 0.50 D and 90% within ± 1.00 D. Both groups showed a refraction correction of 0.50 D or more in 36% and 31% of eyes, in the higher-PTA and the lower-PTA groups, respectively.


Percent tissue altered index should not be considered as a unique variable in post-LASIK ectasia risk assessment. Ectasia susceptibility screening should integrate tomography and biomechanical variables in order to help us to decide any refractive treatment choice and increasing refractive surgery safety.

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Correspondence to José-María Sánchez-González.

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This study was conducted in accordance with the tenets of the Helsinki Declaration and obtained Institutional Review Board approval.

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All patients included in this work were adequately informed verbally and in writing of the benefits, characteristics and risks of the surgeries. All patients signed an informed consent prior to the surgery and after the interview performed with the ophthalmologist.

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Rocha-de-Lossada, C., Sánchez-González, JM., Rachwani-Anil, R. et al. Could the percent tissue altered (PTA) index be considered as a unique factor in ectasia risk assessment?. Int Ophthalmol 40, 3285–3294 (2020).

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