Complication Of Refractive Surgery Research Articles

Discussion by Alvaro Rodriguez, MD

The authors describe (1) four cases of retinal detachment occurring after posterior chamber phakic intraocular lens (PCPIOL) implantation for the correction of high myopia and (2) the refractive surgery complications in two patients with previously placed encircling scleral buckles for retinal detachment in whom corneal steepening developed after laser in situ keratomileusis (LASIK).

Clinical Results and Complications of Refractive Surgery

To evaluate the efficacy of photorefractive keratectomy (PRK) with a scanning type excimer laser MEL-60 (AESCLUP-MEDITEC, Co). We performed PRK on 102 eyes of 62 myopic patients whose refraction ranged from-3.00 to -12.50 D (mean, -6.47 D) and examined the clinical results of postoperative refraction and complications. At 12, 18, and 24 months after the operation, the mean refraction was -1.57 +/- 1.25D, -1.63 +/- 1.51 D and -1.73 +/- 1.47 D. At 12 months after the operation, 36 eyes (46.2%) were within +/- 0.5 D of intended correction, 61 eyes (78.3%) within +/- 1.0 D, and 76 eyes (97.4%) within +/- 2.0 D. Twenty-four months after the operation, 12 eyes (37.5%) were within +/- 0.5 D, 18 eyes (56.3%) within +/- 1.0 D and 29 eyes (90.6%) within +/- 2.0 D. The complications were as follows: keratitis filamentosa was observed in 10 eyes (10.5%), decrease of contrast sensitivity in 7 eyes (7.4%), subepithelial corneal haze in 4 eyes (1.2%), steroid-induced glaucoma was 2 eyes (2.1%), increase of astigmatism in 2 eyes (2.1%), decrease of best corrected visual acuity in 2 eyes (2.1%), and corneal ulcer in 1 eyes (1.1%). PRK with a scanning type excimer laser MEL-60 was effective to reduce refractive error in low and mild myopia, but there were some complications, so that a long, careful follow-up seems necessary.

Discussion by Robert K. Maloney, MD

Bilateral simultaneous refractive surgery remains controversial. Opponents argue that a catastrophic complication could occur bilaterally if simultaneous surgery is performed. With sequential surgery, the outcome in the first eye can be assessed; if a catastrophic complication occurs, the surgeon may then choose not to operate on the second eye. Proponents argue that catastrophic unilateral complications of refractive surgery are very rare, 1 Lin R.T. Maloney R.K. Flap complications of lamellar refractive surgery. Am J Ophthalmol. 1999; 127: 129-136 Abstract Full Text Full Text PDF PubMed Scopus (256) Google Scholar so bilateral catastrophic complications are sufficiently rare that the risk is acceptable. Although mild or treatable complications are relatively common, 1 Lin R.T. Maloney R.K. Flap complications of lamellar refractive surgery. Am J Ophthalmol. 1999; 127: 129-136 Abstract Full Text Full Text PDF PubMed Scopus (256) Google Scholar such a complication on the first eye would not lead a surgeon performing sequential surgery to decide not to operate on the second eye.

Outcome of Cornea, Iris, and Lens Perforation During Automated Lamellar Keratectomy-Reply

<h3>In reply</h3> Dr Teichmann is completely correct. The oscillating blade of the automated keratome is in a fixed position. The thickness of the excised cornea is determined by a depth plate that limits the protrusion of corneal tissue above the plane of the blade. If the plate is not properly seated, excessive corneal protrusion may allow a full-thickness incision. As the intraocular pressure is intentionally elevated by a suction ring, often to 65 mm Hg, the intraocular contents are immediately forced into such a perforating wound. In the case reported, the plate had not been fully seated in the automated keratome. The comments of Dr Teichmann remind us that accuracy and precision are as important when reporting the outcomes and complications of refractive surgery as when performing the surgery itself.

Strabismus Induced by Radial Keratotomy

The history of a woman who developed diplopia after radial keratotomy is reported. Examination showed that this was the result of the appearance of accommodative esotropia. Some complications of refractive surgery reported in the literature were reviewed. It is the current policy of the U.S. military services to disquality an applicant for entry who has undergone refractive surgery. Based on this review of complications it is argued that this is still the correct policy.