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LASIK pitfalls include increased aberrations, keratectasia, flap irregularities
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CLEVELAND — LASIK has the potential for complications that are not seen in other refractive procedures, including increased coma, keratectasia and surgeon-induced irregular flaps, according to presenters here.
Several surgeons described complications seen in LASIK but not in surface ablation procedures such as laser epithelial keratomileusis (LASEK) here at the International Congress on LASEK and Advanced Surface Ablation.
Raymond A. Applegate, OD, PhD, compared the amount of residual and induced aberrations following LASIK, LASEK and photorefractive keratectomy (PRK) in myopic patients. All three surgical procedures reduced second- and third-order aberrations postoperatively, but LASIK induced the most higher-order aberrations.
“The increase in coma for LASIK patients was significant,” Dr. Applegate said. Additionally, the study found that there was significantly more variability in the predictability of LASIK outcomes than the other refractive procedures.
Another complication of LASIK not seen in LASEK or PRK is keratectasia, said David Huang, MD.
“Keratectasia is a rare, but serious, complication of LASIK,” Dr. Huang said. According to Dr. Huang, the incidence of keratectasia in LASIK patients is one case per 2,500 patients.
Surgeons can reduce the incidence of keratectasia by following conservative guidelines, Dr. Huang said. This includes leaving adequate corneal stability by preserving a thickness of greater than 250 µm in the stromal layer.
“Ruling out forme fruste keratoconus by measuring with intraoperative pachymetry will also reduce your chances of a postop ‘surprise’ with keratectasia,” Dr. Huang added.
Flap irregularities are also unique to LASIK, the most common flap-based refractive procedure, said Ronald R. Krueger, MD.
“Flap complications are very common,” he said. “Most, like free caps, happen during surgery and can be corrected with appropriate methods.”
A free cap can be corrected by replacing the cap and sealing the cornea with a contact lens, he said. However, Dr. Krueger said, not all flap complications can be corrected definitely.
“We as surgeons must use proper planning to prevent all of these complications,” he said. “If we cannot resolve these challenges with LASIK, it leads us to question whether surface procedures, such as LASEK and PRK, will someday become more popular.”