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Excimer laser surgery effective for collagen vascular diseases
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Excimer laser surgery improved uncorrected distance visual acuity, improved refractive outcomes and limited complications for patients with immune-mediated inflammatory disease, according to a study.
With proper patient selection, screening and counseling, laser vision correction for patients with well-controlled collagen vascular disease, without evidence of ocular involvement, can be safe and effective, Julie M. Schallhorn, MD, MS, told Ocular Surgery News.
“What we saw in this study is that the likelihood of ocular disease activation in the setting of well-controlled systemic disease without history of eye involvement is very low. This probably reflects the fact that, in these cases, the stimulus of laser vision correction is usually not enough to activate the inflammatory disease,” she said.
The study included 1,224 eyes of 622 patients, with 50.6% of the cohort diagnosed with rheumatoid arthritis, 19.5% with systemic lupus erythematosus, 10.5% with psoriatic arthritis, 10% with sarcoidosis, 6.4% with ankylosing spondylitis, 1.9% with multiple sclerosis and 1.1% with scleroderma.
Patient files were reviewed at Optical Express in Glasgow, U.K. Between 2008 and 2015, 1,114 eyes underwent LASIK and 110 eyes underwent PRK. Mean follow-up was 10.9 months.
Of 916 eyes (837 LASIK, 79 PRK) with a minimum follow-up of 3 months and an emmetropic target, 685 of the LASIK eyes and 65 of the PRK eyes were within ±0.5 D of emmetropia. Additionally, 778 of the LASIK eyes and 77 of the PRK eyes were within ±1 D of emmetropia.
A total of 643 LASIK eyes and 58 PRK eyes had a postoperative uncorrected distance visual acuity of 20/20 or better. Ten LASIK eyes lost two lines or more of corrected distance visual acuity, and 19 eyes gained two lines or more. No eyes in the PRK group lost two or more lines of corrected distance visual acuity.
“The most likely reason for reduction in best corrected acuity was postoperative surface issues. These patients should be counseled about possible extended need for ocular surface lubricants and extra surface care. They should also be informed that there is a rare but potentially serious risk of activation of their disease. We didn’t really see that in our study, but it has been reported, and patients do need to be informed of this,” Schallhorn said.
One patient developed a peripheral flap melt postoperatively that responded to topical steroid treatment, but no other unexpected complications were reported. Of all patients, 384 in the LASIK group and 33 in the PRK group experienced dry eye symptoms. The majority of patients with dry eye symptoms experienced them for 6 months or less.
Schallhorn said patients with dry eye symptoms after excimer laser surgery should be treated early and aggressively with topical preservative-free tears and anti-inflammatories such as steroids, Restasis (cyclosporine, Allergan) or Xiidra (lifitegrast, Shire).
While the results of the study were encouraging, physicians should remember to exercise caution when dealing with this patient population, Schallhorn noted.
“Although our paper showed great results, I want to emphasize that this was in a carefully selected patient population with no evidence of ocular disease prior to surgery, including keratoconjunctivitis sicca. Patients were also required to obtain a letter from their rheumatologist stating that their systemic disease was quiescent. Our results showed that, in this subset of patients, results are favorable, but treating physicians should have a higher level of caution when dealing with this patient population,” she said. – by Robert Linnehan
- Reference:
- Schallhorn JM, et al. J Cataract Refract Surg. 2016;doi:10.1016/j.jcrs.2016.09.018.
- For more information:
- Julie M. Schallhorn, MD, MS, can be reached at Department of Ophthalmology, University of California, San Francisco, 10 Koret Way, San Francisco, CA 94143; email: julie.schallhorn@ucsf.edu.
Disclosure: Schallhorn reports receiving lecture honoraria from Avellino Labs.