Complication Prevention and Resolution

Looking at a long list of potential complications from refractive surgery can be overwhelming. When put into proper perspective, the issue may not seem so dire. There are a gazillion things that can go wrong with any surgery, just like there are a gazillion things that can harm you every day. For most people considering refractive surgery, the more important issue is the probability of something going wrong, not the possibility. Also, it is very important to distinguish between the rate of occurrence of a problem and the rate of an unresolved problem.

It is important to remember that refractive surgery is often more a six-month process than a 20-Minute Miracle. During those six months, treatment may include medications or even an additional enhancement surgery. Fluctuation in vision quality is normal, minor haze, halos, often resolve within weeks, temporary dry eye is relatively common with Lasik and All-Laser Lasik. Nearly all problems that can occur have a resolution available, although that process may be undesirable.

We have listed the most commonly reported complications of the most common refractive surgery techniques. Although these are the most commonly reported complications, they are not very common. About 3% of refractive surgery patients have unresolved complications (all procedures and all kinds of problems combined) at six months after surgery, with about 0.5% of those being complications that require extensive management or aggressive intervention. See Lasik Eye Surgery Expectations. There are a small percentage of refractive surgery patients who have long-term complications.  The possibility of a long-term complication will always exist, even if the probability is very, very small.

A competent doctor will provide every patient with an informed consent before surgery. This document needs to be read closely and fully understood. It will provide a more comprehensive list of potential problems. It is wise to discuss with the doctor the probability of having one of these problems, based upon your own individual circumstances.

Conventional or Custom Wavefront Lasik and All-Laser Lasik
Dry eyes
Over/undercorrection
Halo around light sources
Starburst from light sources
Ghosts/double vision
Light sensitivity
Wrinkles in flap (striae)
Decentered ablation
Unstable cornea
Debris/growth under flap
Epithelium erosion

PRK, Wavefront PRK
Over/undercorrection
Visual acuity fluctuation
Halo around light sources
Starbursts around light sources
Decentered ablation
Corneal Haze
Epithelium erosion

LASEK, Wavefront LASEK, Epi-Lasik, Wavefront Epi-LASEK
Same as PRK plus
Loss of epithelial flap

CK
Over/undercorrection
Visual acuity fluctuation
Light sensitivity
Glare sensitivity
Induced astigmatism
Regression

Intacs
Over/undercorrection
Visual acuity fluctuation
Light sensitivity
Glare sensitivity
Induced astigmatism

P-IOLs
Over/undercorrection
Endothelium cell loss
Trauma induced cataract
Induced astigmatism

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik, NearVision CK, RLE, or any refractive surgery procedure, we highly recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Laser Eye Surgery Doctor.

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.

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Current Lasik Medical Journal News...

Tandem Scanning Confocal Microscopy of Cornea After Descemet Stripping Automated Endothelial Keratoplasty.

Related Articles

Tandem Scanning Confocal Microscopy of Cornea After Descemet Stripping Automated Endothelial Keratoplasty.

Eye Contact Lens. 2009 Jun 4;

Authors: Prasher P, Muftuoglu O, Bowman RW, McCulley JP, Petroll WM, Cavanagh HD, Mootha VV

PURPOSE:: To evaluate the changes in the corneal stroma after Descemet stripping automated endothelial keratoplasty (DSAEK) using tandem scanning confocal microscopy (CM). METHODS:: Thirteen eyes of 13 patients who underwent DSAEK without preoperative corneal haze or scar obvious at the slit lamp, any ocular disease, and postoperative complication were included in the study. All patients were examined clinically and by CM 6 months after DSAEK. RESULTS:: Six months after DSAEK, none of the eyes had clinically significant interface haze (i.e., haze affecting quantity or quality of vision) at slit lamp. The mean best spectacle corrected visual acuity was 0.18 +/- 0.12 (range 0-0.4) logMAR (Snellen 20/30). The CM revealed highly reflective particles in interface in six eyes, particles with mild surrounding increased reflectivity in four eyes, and no discernible interface in three eyes. The mean particles density at interface was 28.6 +/- 23.4 particles/mm. No significant keratocyte activation was seen in any case at the interface. The mean anterior stromal reflectivity was 431.2 +/- 269.1 confocal back scatter units (CBU) and the mean interface reflectivity was 65.9 +/- 46.9 CBU. The mean anterior stromal reflectivity was significantly greater than the mean interface reflectivity (P<0.01). Significant keratocyte activation with high reflectivity was seen in superficial anterior stroma in 8 of 13 eyes. CONCLUSIONS:: Tandem scanning CM shows the presence of highly reflective particles at the level of the DSAEK interface that are morphologically similar to a laser in situ keratomileusis interface. The stromal reflectivity is more prominent in subepithelial layers than that of interface 6 months after DSAEK. However, the areas under the mean reflectivity peaks (CBU) corresponding to the flap interface and superficial anterior stroma do not seem to correlate with best spectacle corrected visual acuity results after the procedure.

PMID: 19502987 [PubMed - as supplied by publisher]