Complications with LASIK

by Jay Stockman

LASIK, surgery to reduce or eliminate the need for eye glasses, has become very popular over the past 5-10 years. While most cases proceed quite well, the potential for complications does exist, and is often not discussed prior to surgery. It should be noted that all but one of the complications is NOT due to surgeon error. Most potential problems are simply physiological, and have nothing to do with how well the surgeon performed the procedure.

The first is infection. While topical antibiotics are employed prior to, and after the surgery, there is always the possibility of infection if the individual is exposed to an infectious agent. The cure is simple; proper follow up and more antibiotics. There is minimal risk of further issues.

The second, is movement of the flap. This will occur if the individual rubs his/her eye before the flap has had proper time to reattach itself to the underlying tissue. The patient will experience pain, blurry vision and redness if this occurs. It is an emergency, and does require being brought back into surgery to move the flap back into position.

Once this is done, the individual should heal normally without further complications. This flap movement tends to occur more frequently when Intralase (laser is used to lift the flap) is performed. While the incision is more precise, it results in a very thin flap which tends to move easier post surgically. Once the flap heals though, the incision area is barely noticeable.

The third complication is epithelial (outside) cell growth under the flap. This may occur days to months after surgery. These cells grow around the edge of the flap, and move inward causing haziness under the flap. When this occurs, the flap must me lifted up and these epithelial cells washed away. No further problems will occur after this procedure is done.

The fourth issue is striae, or wrinkles in or under the flap. This is corrected by lifting the flap and flattening it out. No long term issues after this point.

Issue five is extreme swelling often called " Sands of the Sahara", because it looks like a sand dune to the examining eye doctor. This may occur more frequently, but is dealt with higher doses of steroid eye drops to reduce the inflammation. As with the other complications, the results are most often successful.

The final and most serious of the potential complication is ectasia. This occurs when the inner most layer of the cornea, the endothelium, has irregularities in it. If this issue is not detected prior to surgery the final results after LASIK may be terrible. The patient may have poor, distorted and irregular vision that is NOT surgically correctable, nor corrected with glasses.

Most often the individual will either have to wear hard contact lenses, and may even require a cornea transplant to improve his/her vision. This complication is the only one that could be surgeon related. A test called the Orbscan MUST be performed prior to surgery, and the potential for ectasia can be easily detected.

NO INDIVIDUAL SHOULD EVER consider LASIK with out having an Orbscan done. Any office that does not have an Orbscan should not perform LASIK.

As with all surgical procedures, patients must be comfortable with the surgeon and the office they choose, and understand all the potential complications prior to surgery.

Jay B Stockman O.D. is a practicing doctor for New York Vision Associates and a prolific writer. Visit New York Vision Associates for more information.

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