Laser in situ keratomileusis in patients with autoimmune diseases

Abstract

Laser in situ keratomileusis may be a reasonable option in patients with well-controlled or inactive autoimmune disease.

Surgically induced corneal necrotizing keratitis following LASIK in a patient with inflammatory bowel disease

“…These studies concluded that LASIK could be a reasonable option in these patients, but the authors advised counseling the patient about the uncertainty of the refractive outcome and the possibility of corneal melt before surgery. 4 Recent studies suggest that the risk for corneal complications after LASIK in patients with quiescent autoimmune disease is minimal. [2][3][4] To our knowledge, this is the first description of corneal melt following LASIK refractive surgery in a patient with IBD.…”

“…4 Recent studies suggest that the risk for corneal complications after LASIK in patients with quiescent autoimmune disease is minimal. [2][3][4] To our knowledge, this is the first description of corneal melt following LASIK refractive surgery in a patient with IBD. Our case suggests that corneal melt may occur after corneal surgery even in patients with clinically inactive disease.…”

“…2 For these reasons, autoimmune diseases are generally regarded as a relative contraindication to keratorefractive procedures. However, there is controversy about candidacy for refractive procedures: Some authors have reported no severe complications or unfavorable outcomes after laser in situ keratomileusis (LASIK) in patients with autoimmune diseases, 3,4 whereas the United States Food and Drug Administration has listed autoimmune diseases as a group to be a contraindication to laser refractive surgery because of less predictable wound healing with the potential for corneal melt. 2 We describe a case of surgically induced necrotizing keratitis after LASIK in a patient who had not disclosed a previous total colectomy for recurrent active ulcerative colitis.…”

Excimer laser refractive surgery in patients with underlying autoimmune diseases

“…Should cataract surgery become necessary in these patients, as it is necessary in all patients eventually, newer methods significantly improve the accuracy of intraocular lens power calculation after LASIK. 1 Because of these advances, I believe it is unnecessarily dogmatic to say that autoimmune connective tissue diseases should be a ''red light'' for refractive surgery. It was not the intention of our paper or of Kohnen's editorial to suggest that these patients are a ''green light'' for surgery.…”

“…I would like to address some points in Kohnen's recent editorial 1 about excimer laser refractive surgery in patients with underlying autoimmune diseases. First, after reading the editorial, one may think that there is no significant systemic contraindication for excimer laser refractive surgery; ie, the procedure can be safely performed in patients previously on the Red List (forbidden for operation) for refractive surgery if the disease is stable, a concept that should be reconsidered.…”