RESULTS AND COMPLICATIONS OF LASER IN-SITU KERATOMILEUSIS BY EXPERIENCED SURGEONS

PURPOSE: To identify intraoperative and early postoperative adverse ev ents and complications that may be encountered after the laser in-situ keratomileusis (LASIK) learning process. METHODS: One hundred sixty-n ine consecutive eyes of 108 patients who had LASIK, by a surgeon exper ienced in LASIK were studied. All intraoperative and early postoperati ve adverse events and complications were noted. Patients were examined at 1 day and 1 to 3 months after surgery. Six baseline refractive gro ups were studied: high myopia with astigmatism (-10.25 to -17.50 D; 18 eyes), moderate myopia with astigmatism (-6.00 to -9.50 D; 31 eyes), low myopia with astigmatism (-0.75 to -5.87 D; 81 eyes), mixed astigma tism (-0.25 to +0.50 D; 6 eyes), low to moderate hyperopia with astigm atism (+1.00 to +3.75 D; 19 eyes), and high hyperopia with astigmatism (+4.25 to +7.37 D; 12 eyes). Seventy-eight percent (132 eyes) had a p rimary LASIK procedure; 22% (37 eyes) had LASIK after previous refract ive surgery. Primary and secondary LASIK procedures were analyzed toge ther. The Nidek EC-5000 or the Chiron PlanoScan excimer lasers were us ed. RESULTS: The most commonly observed adverse intraoperative events were minor corneal bleeding (3%) and thin flap (1%). The most commonly observed postoperative events were punctate epithelial keratopathy (6 %) and small epithelial defect 1 day after surgery (5%). The most seri ous complication occurred in three eyes with preoperative high hyperop ia (spherical equivalent refraction greater than +4.00 D) in which cor neal topographic abnormalities resulted. At last examination, mean pos toperative spherical equivalent refraction was less than +1.00 D in al l groups. Spectacle-corrected visual acuity was 20/20 in 70 eyes (41%) and 20/25 or better in 119 eyes (70%). Loss of spectacle-corrected vi sual acuity of two or more lines occurred in five eyes (3%), three of which had preoperative high hyperopia with abnormal postoperative corn eal topography. CONCLUSION: Our prospective study should help LASIK su rgeons gauge their expectations of intraoperative and early postoperat ive complications. Surgeons should proceed cautiously when treating pa tients with high hyperopia, because a higher incidence of loss of spec tacle-corrected visual acuity may be encountered postoperatively.