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Purpose
To evaluate the current United States Food and Drug Administration (FDA) recommendations regarding laser in situ keratomileusis (LASIK) surgery in patients with collagen vascular diseases (CVD) and assess whether these patients make appropriate candidates for laser vision correction, and offer treatment recommendations based on identified c...
Context in source publication
Context 1
... major diseases in this group traditionally include rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and the seronegative spondyloarthropathies (SpA; ankylosing spondylitis, reactive arthritis, and psoriatic arthritis). All of these diseases have well-documented eye manifestations (Table 1). ...
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Background
To evaluate the efficacy and patient satisfaction of laser in situ keratomileusis (LASIK) monovision correction in presbyopic emmetropic patients.
Methods
A retrospective review of 294 patients who underwent LASIK for monovision was conducted. All patients had preoperative uncorrected distance visual acuity in each eye of 20/25 or bette...
Purpose
To determine the factors associated with retreatment after laser in situ keratomileusis (LASIK) for myopic eyes in the modern LASIK era.
Setting
Care-Vision Laser Centers, Tel-Aviv, Israel.
Design
Retrospective cohort study.
Methods
All cases of myopic LASIK performed between January 2005 and December 2012 were analyzed according to whet...
The purpose was to evaluate subjective quality of vision and patient satisfaction after laser in situ keratomileusis (LASIK) for myopia and myopic astigmatism.
A self-administered patient questionnaire consisting 29 items was prospectively administered to LASIK patients at the Yemen Magrabi Hospital. Seven scales covering specific aspects of the qu...
Background
In this retrospective randomized case series, we compared bilateral symmetry between OD and OS eyes, intercorneal differences and Functional Optical Zone (FOZ) of the corneal aberrations.
Methods
Sixty-seven normal subjects (with no ocular pathology) who never had any ocular surgery were bilaterally evaluated at Augenzentrum Recklinghau...
Swept-source optical coherence tomography (OCT) is the latest advancement in anterior segment imaging. There are limited data regarding its performance after laser in situ keratomileusis (LASIK). We compared the reliability of swept-source OCT and Scheimpflug imaging for evaluation of corneal parameters in refractive surgery candidates with myopia...
Citations
... Uncontrolled connective tissue disorders, diabetes mellitus, pregnancy, lactation and keloids are relative contraindications for refractive surgery. 2,3 One should also enquire about family history of corneal ectasia. Concurrent use of medications like isotretinoin, amiodarone and hormone replacement therapy can significantly impact the outcomes of refractive surgery. ...
... Autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, and Sjögren's syndrome are diagnoses that require stringent presurgical attention. To qualify for ocular surgery, patients with these diseases should consult with their rheumatologist to confirm their eligibility for surgery and should have a mild, stable, and well-controlled dry eye condition [29,104,105]. ...
Background
An impaired ocular surface presents substantial challenges in terms of planning for cataract surgery. As a multifactorial ocular disorder, dry eye disease (DED) is common in the general population and prevalent in patients scheduled for lens replacement surgery. Cataract surgery can exacerbate DED and worsen several ocular parameters. Timely diagnosis and appropriate treatment of DED are vital to ensuring positive ophthalmic surgical outcomes.
This consensus report of the Taiwan Society of Cataract and Refractive Surgeons (TSCRS) regarding the management of DED before, during, and after cataract surgery highlights the gaps between clinical guidelines and several aspects of DED, including diagnostic testing, diagnostic criteria, and clinical practice treatment.
Methods
An expert panel of five specialists in the field of ophthalmology was recruited to develop consensus statements regarding the management of DED in both the general population and in patients undergoing cataract surgery in Taiwan. Two separate meetings of the five specialists, who were endorsed by the TSCRS, were convened for this purpose. A survey questionnaire consisting of binary or multiple-choice questions was developed through a consensus-driven formulation process. A percentage value was calculated for each statement, and a minimum of 60% agreement (equivalent to three out of five members) was required to achieve consensus. The second discussion meeting involved the presentation of the finalized consensus statements and concluded the consensus development process. Lastly, the finalized consensus statements were approved by all the experts, and the formulated recommendations for DED in the general population and prospective cataract surgery patients were accordingly presented.
Results
The optimal algorithm for managing DED in the general population and in patients scheduled for cataract surgery was developed to address the unmet needs of this cohort in Taiwan.
Conclusion
This report provides recommendations for managing dry eye disease. It is essential to screen and confirm DED through endorsed questionnaires and tests and then diagnose it. Treatment and management of DED should follow a stepwise approach. Screening and diagnosing DED is also recommended before cataract surgery. After cataract surgery, relatively aggressive treatment strategies are recommended to manage DED effectively.
... It is known that there is an association between autoimmune diseases like SLE and keratoconus as this gives insight into the pathogenesis and pathophysiology of keratoconnus [216]. LASIK procedures are therefore contraindicated for SLE sufferers [217]. Also, scleritis is a known presentation in SLE and it manifests as both nodular and diffuse scleritis with a known distribution of 1% from other studies [218][219][220]. ...
Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder characterized by immune dysregulation and multi-organ involvement. In this concise brief review, we highlight key insights into Ocular Systemic Lupus Erythematosus (SLE), an intricate autoimmune disorder with diverse organ involvement. Emphasizing the formation of autoantibodies and immune complex deposition, we delve into the inflammation and damage affecting ocular structures. Clinical presentations, ranging from mild dry eye syndrome to severe conditions like retinal vasculitis, necessitate a comprehensive diagnostic approach, including clinical exams, serological testing, and imaging studies. Differential diagnosis involves distinguishing SLE-related ocular manifestations from other autoimmune and non-inflammatory ocular conditions. The multidisciplinary management approach, involving rheumatologists, ophthalmologists, and immunologists, tailors treatment based on ocular involvement severity, encompassing corticosteroids, immunosuppressive agents, and biologics. Follow-up is crucial for monitoring disease progression and treatment response. Future perspectives revolve around advancing molecular understanding, refining diagnostic tools, and exploring targeted therapies. Novel research areas include genetic factors, microbiome composition , and biotechnology for tailored and effective SLE ocular treatments.
... The ocular symptoms of RA include episcleritis and scleritis, which affect 5-10% of patients with RA. The acute keratitis occurs in 30-70% of cases with RA-related episcleritis or scleritis [5]. The pathophysiology of scleritis in RA patients comprise the immune complex deposition in scleral vessels, fibrinoid necrosis and thrombotic occlusion of blood vessels which results in a fulminant inflammatory response with severe pain of the eye [5]. ...
... The acute keratitis occurs in 30-70% of cases with RA-related episcleritis or scleritis [5]. The pathophysiology of scleritis in RA patients comprise the immune complex deposition in scleral vessels, fibrinoid necrosis and thrombotic occlusion of blood vessels which results in a fulminant inflammatory response with severe pain of the eye [5]. Systemic lupus erythematosus (SLE) is characterized by autoimmune inflammatory affection of multiple organ systems. ...
... There are some ocular complications of SLE including: secondary Sjögren's syndrome with keratoconjunctivitis sicca or lupus retinitis. The corneal complications of SLE are the consequence of basement membrane tissue impair-ment due to the immune complex, which are stimulated by the chronically activated complement system [5]. Seronegative spondyloarthropathies (SpA) is a group of autoimmune entities commonly affecting the spinal cord and peripheral joints. ...
Laser vision correction (LCV) is a common corneal surgery for the treatment of refractive errors. The rapid development of LVC techniques make this procedures safe and efficient. Despite the high safety profile of corneal refractive surgery, there are however some clinical conditions that constitute absolute or relative contraindication for this procedures. The aim of the paper was to overview and summarise the currently known systemic contraindications for LVC.
... Pregnancy or lactation were exclusion criteria for the surgery (1,6). Also excluded were patients with systemic diseases that could interfere with the wound-healing process (e.g., diabetes mellitus, autoimmune disorders) (1,6,26,27) or with risk of postoperative low visual acuity due to possible vascular complications including ischemic optic neuropathy or vascular occlusion (e.g., severe systemic hypertension, severe dyslipidemia and cardiovascular diseases) (7,9,(28)(29)(30). ...
Incidence and clinical results of intraoperative flap and interface-related complications were investigated after Femtosecond-LASIK surgery, where flap creation was performed with VisuMax® femtosecond laser. A retrospective 10-year cohort study was conducted including all eyes treated for all refractive errors by Femtosecond-LASIK technique. All the flaps were made by the same refractive surgeon with the VisuMax® (Carl Zeiss Meditec) femtosecond laser. We report the intraoperative flap and interface-related complications in these eyes, also describing their management. The study included 4,032 eyes. Flap and interface-related complications were: opaque bubble layer (OBL) 21.18%, suction loss 1.29%, difficult docking 0.69%, difficult dissection of the flap 0.59%, bleeding from limbal blood vessels 0.35%, de-epithelialization of the flap 0.12%, and interface debris 0.025%. These situations were appropriately addressed, with favorable outcomes. Flap creation is an important step in LASIK surgery. The predictability and safety have improved since the flap incision is assisted by a femtosecond laser, but complications of the flap and interface can still occur during the flap creation. Refractive surgeons should be aware and properly manage any unusual situation.
... Absolute systemic contraindications are poorly controlled systemic immune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus, polyarteritis nodosa), as well as poorly controlled diabetes and AIDS. Such patients have a higher risk of complications associated with prolonged inflammation or corneal healing after refractive surgery [18,[22][23][24]. Surgical procedures are not recommended during pregnancy and lactation [25]. ...
... Instability of refraction (i.e., a change greater than 0.50 D within a year) is considered as an absolute contraindication, as well as insufficient corneal thickness or corneal irregularities suspicious for keratoconus [21,26,28,29]. Precautions are also needed in patients with certain systemic therapies (isotretinoin, amiodarone, sumatriptan, colchicine) [23,24,30]. Caution is also required in functional monocular patients and in patients with well-controlled glaucoma. ...
Myopia is the most prevalent refractive error in the world and its incidence is increasing. Together with conservative methods of treatment, various surgical methods have been proposed. Corneal refractive surgery is probably the most accepted one. Laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE) are suitable for treatment of myopia up to −8.00 D in the younger age group. For patients not suitable for corneal refractive surgery, lens-based procedures are available. Phakic intraocular lenses are suitable for patients younger than 45 years of age with high myopia or some other contraindications for corneal refractive surgery. For older patients, refractive lens exchange (RLE) with implantation of multifocal or monofocal intraocular lenses is gaining popularity.
... These complications may include high order aberrations (HOA), dry eyes, halos, and flap complications (such as displaced flap, folds in the flap, slipped flap, and flap interface particles). [8][9][10][11] Small-incision lenticular extraction (SMILE) is a new flapless surgical procedure that avoids flap-related complications. [12,13] Although similar to Q-FS-LASIK, SMILE uses a single femtosecond laser referenced to the corneal surface to create the lenticule, which will be removed manually. ...
Previous studies compared ocular aberration and visual quality after small-incision lenticule extraction (SMILE) and Q value-guided femtosecond laser-assisted in situ keratomileusis (Q-FS-LASIK), but anterior corneal surface aberration properties are poorly known. This study aimed to compare the changes in anterior corneal surface aberration after SMILE versus Q-FS-LASIK.
This was a prospective, observational cohort study. Patients with myopia and myopic astigmatism underwent SMILE or Q-FS-LASIK at Hangzhou MSK Eye Hospital between January 2015 and November 2015. High order aberration (HOA), primary spherical aberration (PSA), primary coma aberration (PCA), primary vertical coma aberration (PVCA), and primary horizontal coma aberration (PHCA) were assessed using pre- and postoperative Sirius scanning.
Both surgery were associated with significant increases in postoperative HOA, PSA, and PCA (both groups P < .01). In the SMILE group (n = 51), the variations in HOA, PSA, and PCA were no longer significant after postoperative week 2 (P > .05). In the Q-FS-LASIK group (n = 73), the variations in HOA and PCA were no longer significant after postoperative day 1 (P > .05). In the SMILE group, the 3-month changes in PCA were not correlated with spherical, spherical equivalent (SE), and spherical plus cylinder measurements. Cylinder measurements were not correlated with HOA, PSA, and PCA. In the Q-FS-LASIK group, the 3-month changes in PCA correlated with spherical, SE, and spherical plus cylinder measurements.
Both SMILE and Q-FS-LASIK resulted in an increase in HOA, PSA, and PCA at postoperative day 1, but Q-FS-LASIK introduced lower HOA and showed better stability. Spherical measurement was related to PSA.
... These conditions target collagens, which can potentially cause corneal melting. 5 Any of the above if an absolute contraindication would clearly prevent LVC from being performed, whilst a relative contraindication would need to be placed within context and discussed as part of the consent process, individualised and set against the expectations of the patient. ...
It is estimated that over 40 million people have had laser vision correction worldwide since 1991. Laser-assisted subepithelial keratomileusis is commonplace in the UK in high street chains and from more bespoke suppliers. The standards around this treatment have always been regulated by the General Medical Council (GMC), but litigation cases have been common. The recent GMC guidance for cosmetic procedures and subsequent guidelines by the Royal College of Ophthalmologists cover advertising, facility regulations, equipment, consent and surgeon training which should improve industry practices and deliver improved patient safety standards.
... Given the possibility of increased risk in atopic patients, it is advisable to control and stabilize the patient's allergic condition before performing LASIK. The Food and Drug Authority (FDA) has named CVD a LASIK contraindication, as many CVDs can have a component 290 of dry eye [57] and usually of higher severity, as reported in patients with rheumatoid arthritis [58]. However, research has produced conflicting evidence on the safety profile of LASIK on this group of patients. ...
... However, research has produced conflicting evidence on the safety profile of LASIK on this group of patients. One paper [57] has reviewed studies on LASIK in patients with CVDs, in particular the four major AQ3 295 diseases: rheumatoid arthritis, systemic lupus erythematosus and seronegative spondyloarthropathies. This study concluded that together with stringent selection of only patients with mild, stable and well-controlled systemic condition, LASIK surgery may be safe in most patients with CVD with the exception of 300 Sjogren's syndrome. ...
... The Food and Drug Authority (FDA) has named collagen vascular disease (CVD) a LASIK contraindication, as many CVDs can have a component of dry eye [57] and usually of higher severity, as reported in patients with rheumatoid arthritis [58]. ...
Dry eye is the most common post-operative complication in patients who undergo laser-assisted in situ keratomileusis and other photorefractive procedures. Epidemiological studies have found that almost all patients experience some form of dry-eye-related discomfort in the post-operative period. This review seeks primarily to identify patient factors, which predispose to this complication, as well as outline the possible interventions clinicians can consider to avoid, prevent and treat this complication. Numerous pre-, intra- and post-operative guidelines are provided. The ideal method of post-laser-assisted in situ keratomileusis dry eye prevention is a meticulous peri-operative management plan, as opposed to post-operative management alone. Newer modalities of photorefractive surgery may have differing effects on the ocular surface.
