Intraocular Pressure–Based Corneal Remodeling Laser Surgery:

LAREK (Laser Remodeling Keratectomy)

A thin peripheral cornea predisposes both the anterior and posterior corneal surfacesto intraocular 

pressure (IOP)–driven deformation, leading to progressive cornealprotrusion. This biomechanical 

vulnerability contributes to irregular astigmatism, tearfilm instability, and corneal ectatic disorders 

such as keratoconus.

Conventional treatment strategies typically combine customized laser refractivesurgery to flatten 

protruded regions with corneal cross-linking (CXL) to enhancecorneal stiffness. However, 

inadequate CXL may result in recurrent protrusion,whereas excessive CXL can cause corneal haze 

and visual impairment.

Since the early 2000s, efforts have been made to modulate corneal biomechanics. In2015, we 

developed a novel laser surgical technique that leverages intraocularpressure (IOP) to restore and 

maintain a physiologic corneal configuration. Thistechnique, termed LAK and later LAREK, is 

currently applied clinically in Korea forkeratoconus remodeling, with outcomes reported in twelve 

peer-reviewedpublications.

LAREK is a non-destructive and quantitative procedure that preserves the thinnestand most 

protruded corneal regions while selectively correcting thickness deviationin a centrally symmetric 

manner to enhance structural stability. The technique is safe,simple, and compatible with 

conventional treatments, including intracorneal ringsegments and FILI, producing synergistic 

effects in progressive keratoconus.