Elsevier

Ophthalmology

Volume 107, Issue 4, April 2000, Pages 640-652
Ophthalmology

Original Articles
Avoiding serious corneal complications of laser assisted in situ keratomileusis and photorefractive keratectomy

Presented in part at the American Academy of Ophthalmology annual meeting, New Orleans, Louisiana, November 1998.
https://doi.org/10.1016/S0161-6420(99)00131-1Get rights and content

Abstract

Objective

To identify avoidable factors that can lead to serious complications of laser refractive surgery (photorefractive keratectomy [PRK] and laser assisted in situ keratomileusis [LASIK]).

Design

Noncomparative case series.

Participants

Twenty-seven eyes of 19 patients who had undergone either LASIK or PRK with severe complications accrued retrospectively.

Intervention

Review of clinical records.

Main outcome measures

Symptoms, refractive outcome, and assessment of avoidable factors contributing to the complication.

Results

Patients were analyzed in four groups: group 1, scarring with ectasia; group 2, unrecognized keratoconus; group 3, flap related LASIK complications; and group 4, multiple retreatments. The 8 eyes with scarring and ectasia presented with the worst vision, 20/400 uncorrected visual acuity and 20/200 best spectacle-corrected visual acuity, with avoidable factors considered as high or difficult prescriptions with multiple retreatments. Four eyes in two patients with possible forme fruste keratoconus showed worsening irregular astigmatism. Laser assisted in situ keratomileusis flap complications included six eyes with partial laser treatment under an incomplete flap with subsequent severe irregular astigmatism. Six eyes in three patients who had undergone an average of three multiple retreatments showed decreased vision with irregular astigmatism.

Conclusions

Certain severe complications of laser refractive surgery likely can be avoided by using caution when treating high prescriptions, particularly with retreatments, recognizing early keratoconus and avoiding laser treatment under a partial flap in LASIK.

Section snippets

Methods

The study was of a noncomparative case series and was performed by chart review. Institutional review board approval was not obtained. There is no established definition of a serious laser refractive complication, thus the inclusion criteria were: (1) patient referred for further opinion for diagnosis and management of a laser refractive complication; (2) loss of two or more lines of best spectacle-corrected visual acuity (BSCVA), loss of quality of vision such as to interfere with the

Results

Twenty seven eyes of 19 patients were included in the study. Seventeen patients were operated on by one surgeon, with one patient each from two other surgeons. Four patients were referred by their refractive surgeon but most (n = 14) were referred by optometrists without the knowledge of the surgeon. One patient was self-referred.

Discussion

Laser refractive surgery, particularly LASIK, is expanding rapidly and even a low rate of serious complications is of great importance. We studied 27 eyes of 19 patients (PRK, n = 8; LASIK, n = 19) to determine if there were avoidable factors in the development of the complication. Patient were considered to have serious complication if they were visually disabled to the extent they had difficulty with their daily activities, either by virtue of reduced BCVA of more than two lines or decreased

Conclusion

We are unable to draw definite conclusions as to the avoidable factors for serious complications of LASIK and PRK based on this study. Despite the inherent biases in the case selection and definitions, we are concerned by the number of serious complications: 27 eyes in 19 patients accumulated in 18 months. Recognizing the difficulties in drawing conclusions from this group of patients, we do consider that there are several avoidable factors that other laser refractive surgeons may consider in

HSK

A beautiful virus named Jan Worked out a wonderful plan. Her figure dendritic Proved Viropto-lytic, And Metaherpetic she’d play with her man. William C. Conrad, M.D. Warner Robins, GA

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    Supported by The Eye Bank of British Columbia (SH).

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