Abstract
AimTo identify the reasons for refusing refractive surgery in patients visiting for spectacle-free vision.MethodologyMedical records of 296 patients who presented for keratorefractive surgery (KRS) from June 2017 to April 2020 at a tertiary eye care center in central India (Government Medical College and Hospital, Nagpur, Maharashtra, India) were reviewed. Demographic details of all the patients and parameters obtained during workup of a case presented for KRSs were captured in an Excel® sheet and analyzed statistically.ResultsOf the 296 patients who presented for KRS during the study period, 86 (29.1%) patients were denied KRS. The mean pachymetry in the right eye was 505 μm ± 10 μm (range 520-485 μm) and 502 μm ± 7 μm (511-490 μm) in the left eye. Suboptimal corneal thickness (n = 28, 32.6%) was the most common reason for rejection. Other reasons for not recommending the procedure were high myopia (n = 20, 23.3%), spectacle not stable (n = 16, 18.6%), and keratoconus (n = 11, 12.8%). Collagen vascular diseases (n = 3, 3.5%) and anxiety about the procedure (n = 2, 2.3%) were causes unrelated to the procedure. No correlation was observed between corneal thickness and degree of myopia (r = 0.014, p = 0.66).ConclusionPatients presenting for KRS exhibit various problems. Meticulous preoperative evaluation is most important for long-term visual outcome. Suboptimal corneal thickness, high myopia, unstable spectacle correction, and keratoconus were the common reasons for not performing KRS in the study population.
Highlights
The development of excimer laser has improved the safety and efficacy of keratorefractive surgery (KRS)
Of the 296 patients who presented for KRS during the study period, 86 (29.1%) patients were denied KRS
No correlation was observed between corneal thickness and degree of myopia (r = 0.014, p = 0.66)
Summary
The development of excimer laser has improved the safety and efficacy of keratorefractive surgery (KRS). The long-term success of laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) depends on appropriate preoperative assessments. The decision of performing KRS in patients is based on adherence to the set parameters to assess the cornea. All patients aspiring for spectacle-free vision may not benefit from the procedure, and patients with high myopia and thin corneas are not suitable for refractive surgery. Alternative procedures for spectacle-free vision such as implantable contact lenses or lens-based surgery may be advisable for such patients
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