Systemic contraindications for laser vision correction surgery

Abstract

Introduction: Laser refractive surgery corrects refractive errors by changing the shape of the anterior surface of the cornea and its refractive power by using a laser. Patients with refractive errors and systemic comorbidities pose a challenge for refractive surgeons. According to the guidelines of ophthalmological societies, the coexistence of autoimmune connective tissue diseases or hormonal disorders, some pharmacotherapies, pregnancy and lactation are contraindications for refractive procedures. These recommendations have been formulated on the basis of case reports or recommendations coming from other ophthalmic surgeries. Aim: The aim of the study was to summarise the current literature data on systemic contraindications for laser vision correction. Materials and methods: The literature review included the PubMed database. In the search for relevant articles, the following keywords were used: “refractive surgery”, “contraindications”, “LASIK”, “PRK”, “laser in situ keratomileusis”, “photorefractive keratectomy”. The references of articles that met the criteria were also analysed. Discussion: The main reason for considering some systemic conditions and pharmacotherapy as exclusion criteria for refractive surgery was the concern of an increased risk of postoperative eye inflammation, unpredictable healing and corneal remodelling, as well as a severe dry eye syndrome. In recent decades, a number of articles have been published supporting the safety profile of refractive procedures in patients with inactive autoimmune diseases, well-controlled diabetes or undergoing specific pharmacotherapy. These publications were based on either retrospective studies or case series, with short-term follow-up and their results should be interpreted with caution. Conclusions: Active or uncontrolled autoimmune diseases, pregnancy and lactation are absolute contraindications for laser vision correction. The decision to perform refractive surgery in patients with inactive and well- controlled systemic diseases or risk factors should be made individually and carefully by an experienced surgeon.