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...

Five-year outcome of LASIK for myopia.

Related Articles

Five-year outcome of LASIK for myopia.

Ophthalmology. 2008 May;115(5):839-844.e2

Authors: Kato N, Toda I, Hori-Komai Y, Sakai C, Tsubota K

PURPOSE: To investigate the efficacy and safety of LASIK over a 5-year postoperative period. DESIGN: Observational case series. PARTICIPANTS: We examined 779 eyes in 402 patients with myopia or myopic astigmatism who underwent LASIK to correct their refractive errors and received regular postoperative assessments for 5 years. METHODS: Postoperative examinations were performed 1 day; 1 week; 1, 3, and 6 months; and 1, 2, 3, 4, and 5 years after LASIK surgery. MAIN OUTCOME MEASURES: We evaluated changes in uncorrected visual acuity (UCVA) (logarithm of the minimum angle of resolution [logMAR]), manifest refraction, best-corrected visual acuity (BCVA) (logMAR), intraocular pressure, corneal thickness, corneal endothelial cell counts, and complications. RESULTS: Preoperative UCVA of 1.27 improved to -0.03 at 1 day after surgery and -0.08 at 1 month and revealed minimal but significant decreases thereafter. Postoperative manifest refraction was also improved by surgery, showing minimal but significant regression after 1 year. Final BCVA loss was seen in 10 eyes of 7 patients; in 7 cases, there were obvious reasons such as the progression of cataracts in 3 eyes, epithelial disintegrity due to dry eye in 2 eyes, irregular astigmatism due to flap striae in 1 eye, and age-related macular dystrophy in 1 eye. Intraocular pressure and corneal thickness decreased by 4.0 mmHg and 76.9 microm, respectively, due to surgery, but remained stable throughout the follow-up period. Corneal endothelial cell counts (2689.0+/-232.9 cells/mm(2) before surgery) showed a statistically significant decrease at 5 years after surgery (2658.0+/-183.1 cells/mm(2); 1.2% loss for 5 years), likely within the range due to physiological age-related loss. No serious, vision-threatening, irreversible complication such as keratectasia or progressive endothelial cell loss was observed. CONCLUSION: LASIK surgery is an effective and safe procedure for correcting myopia/myopic astigmatism as long as inclusion and exclusion criteria are strictly respected. However, minimal regression occurred during the 5-year investigative period.

PMID: 17900692 [PubMed - indexed for MEDLINE]