LASIK Eye Surgery Complications

Complications in LASIK procedures can arise from a variety of phases in the procedure, from patient selection, to flap-related complications, to excimer laser complications. Some of these complications may be inherent in the procedure. Others result through someone's negligence.

Patient Selection

Certain patients may have conditions that make LASIK surgery inappropriate treatment. Patients whose vision has changed dramatically within the past year and patients with certain systemic or ocular conditions that affect healing should not undergo LASIK surgery. In addition, patients using certain drugs may not represent appropriate candidates for the LASIK procedure.

Systemic conditions, including poorly controlled diabetes, connective tissue disorders such as rheumatoid arthritis, and auto-immune or immunodeficiency diseases such as lupus, contraindicate the use of LASIK. Pregnant or nursing women should also not have LASIK surgery.

A history of herpes affecting the eyes, severe dry eyes, eyelash or eyelid abnormalities, thin corneas, previous eye trauma or inflammation, cataracts, corneal dystrophies, glaucoma, large pupil size, and contact lens warpage are ocular conditions that contraindicate the use of LASIK.

In addition, doctors whose patients take Accutane (an acne treatment), Cordarone (an antiarrythmic cardiac drug), or Imitrex (a migraine headache medication) should advise against LASIK while the patient continues to take one of these medications.

While a surgeon may discover some of these conditions during a patient's physical exam, other conditions may require corneal topography to detect.

Flap-related complications

Beyond complications arising out of poor prescreening of patients, oftentimes complications result from surgical mishaps. When cutting the flap in the cornea, problems including incomplete, torn, irregular, or decentered flaps can occur. A surgeon might also cut the cornea too thin, too thick, or extend the flap so far that the flap is entirely cut off (called a free cap). Such complications may result from improper microkeratome assembly or placement, inadequate or loss of suction, or incomplete microkeratome cut caused by operator error or instrument malfunction.

In the case of flap complications, surgeons can often avoid permanent and serious injury to the patient by discontinuing the surgery and replacing the flap immediately. Severe flap complications, such as perforating the cornea with too deep a cut, however, threaten the loss of the eye. In addition, if the suction ring raises the pressure in the eye to a level that occludes the central retinal artery, and thereby restricts blood flow to the eye, the retina can sustain severe, permanent damage causing impaired vision.

Excimer Laser Complications

Data entry errors and decentration of the laser pulses often account for the complications arising from use of the excimer laser. Because a computer controls the laser portion of the surgery, correct data entry represents a critical step in the success of a LASIK procedure. Also, if the surgeon does not carefully monitor to ensure that laser pulses remain centered on the exposed stroma area, the laser may burn off the wrong parts of the cornea, resulting in unintended changes in the patients vision. In addition, if a laser is not properly maintained it may deliver laser pulses different from that required. All of these errors can cause potentially irreversible vision damage, including poor vision and under or over-correction.

Results of Complications

Complications from LASIK surgery can cause blurry, distorted, or double vision, loss of best-corrected visual acuity (meaning that, even with corrective lenses, a doctor cannot restore the patient's vision to its preoperative level), loss of contrast sensitivity, glare, halo effect, loss of night vision, and under or over correction. Because complete recovery for LASIK patients can take up to six months, one cannot assume that some of these side effects are permanent until at least six months after the procedure. In addition, a surgeon can correct some complication-related side effects through subsequent LASIK surgery.


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