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

Objective: To identify avoidable factors that can lead to serious complicat ions of laser refractive surgery (photorefractive keratectomy [PRK] and las er assisted in situ keratomileusis [LASIK]), Design: Noncomparative case series. Participants: Twenty-seven eyes of 19 patients who had undergone either LAS IK or PRK with severe complications accrued retrospectively. Intervention: Review of clinical records. Main Outcome Measures: Symptoms, refractive outcome, and assessment of avoi dable factors contributing to the complication. Results: Patients were analyzed in four groups: group 1, scarring with ecta sia; group 2, unrecognized keratoconus; group 3, flap related LASIK complic ations; and group 4, multiple retreatments. The 8 eyes with scarring and ec tasia presented with the worst vision, 20/400 uncorrected visual acuity and 20/200 best spectacle-corrected visual acuity, with avoidable factors cons idered as high or difficult prescriptions with multiple retreatments. Four eyes in two patients with possible forme fruste keratoconus showed worsenin g irregular astigmatism. Laser assisted in situ keratomileusis flap complic ations included six eyes with partial laser treatment under an incomplete f lap with subsequent severe irregular astigmatism. Six eyes in three patient s who had undergone an average of three multiple retreatments showed decrea sed vision with irregular astigmatism. Conclusions Certain severe complications of laser refractive surgery likely can be avoided by using caution when treating high prescriptions, particul arly with retreatments, recognizing early keratoconus and avoiding laser tr eatment under a partial flap in LASIK. (C) 2000 by the American Academy of Ophthalmology.