Update on contraindications for laser-assisted in situ keratomileusis and photorefractive keratectomy

Bower, Kraig S.; Woreta, Fasika A.

doi:10.1097/icu.0000000000000055

Cited by 44 publications

(39 citation statements)

References 45 publications

(27 reference statements)

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“…Regarding corneal laser surgery, autoimmune or immune-mediated diseases should be considered relative contraindications, and uncontrolled diseases should be considered absolute contraindications due to the prevailing consensus. 9 Although Alió et al reported good final results following laserassisted in situ keratomileusis (LASIK) procedures for correcting refractive errors of two patients with CD and arthritis and 2 eyes of one patient with UC and arthritis, 10 the major issue was that corneal laser interventions could trigger melting or significant scar formation in patients with autoimmune diseases. Necrotizing keratitis followed by an uneventful LASIK procedure 11 can particularly raise difficulties since it may occur even in cases of stable and controlled IBD.…”

Section: Discussionmentioning

confidence: 99%

Corneal Manifestations of Inflammatory Bowel Disease

Czompa

Barta

Ziad

et al. 2019

Seminars in Ophthalmology

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Purpose: To evaluate detailed corneal parameters of inflammatory bowel disease (IBD) patients, including Crohn's disease (CD) and ulcerative colitis (UC) patients, and to assess associations between anterior segment values and other clinical variables. Methods: This prospective cross-sectional case-control study at a tertiary referral center included 30 CD patients, 36 UC patients and 80 age-and gender-matched controls with no ocular symptoms or ocular surface disorders. All study participants underwent a comprehensive ophthalmological evaluation with special interest in dry eye disease (DED). Corneal parameters were evaluated by Pentacam. Results: The mean age of CD patients, UC patients, and controls was 45.80 ± 11.55 years, 52.00 ± 16.05, and 50.68 ± 14.62, respectively. The average disease duration was 12.72 ± 5.83 years for CD patients and 15.94 ± 10.09 years for UC patients. All pachymetric (center, apex and thinnest) and corneal volume (CV) measurements were significantly decreased, while anterior chamber angle width (ACA) values were significantly increased on both sides in all IBD patients compared to those in controls (p < .05). In addition, several anterior segment parameters were altered unilaterally in CD or UC patients. Negative correlations were found between corneal parameters and Schirmer I test values. Conclusions: Our investigations suggest that IBD patients have thinner corneas compared to that of controls. The coexistence of reduced tear quantity seems to have an additional impact on the thinning of the cornea in IBD patients. Early recognition of corneal impairments, a possible extraintestinal manifestation of IBD, should be included in the disease checkup to reduce vision-threatening developments.

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Section: Discussionmentioning

confidence: 99%

Corneal Manifestations of Inflammatory Bowel Disease

Czompa

Barta

Ziad

et al. 2019

Seminars in Ophthalmology

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“…Changes in visual acuity and spherical equivalent have been reported in eyes of women who became pregnant after LASIK [46]. Although pregnancy normally precludes corneal laser surgery [47], sometimes an early stage pregnancy has inadvertently not been identified. Also, traumatic corneal injury may require corneal surgery or other procedures involving wound healing.…”

Section: Discussionmentioning

confidence: 99%

Plasminogen activator activity in tears of pregnant women

et al. 2017

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PurposePlasminogen activator activity (PAA) in tears of pregnant women was investigated at various gestation times to assess the availability of plasminogen activator for aiding potential corneal wound healing processes during pregnancy.MethodsPAA was measured by a spectrophotometric method. The analysis used 91 tear samples from pregnant and non-pregnant women, supplemented with 10 additional tear PAA measurements from non-pregnant women obtained in a previous study.ResultsTear levels of PAA in pregnant women formed a bimodal distribution. Either the tear PAA level was zero or non-zero during pregnancy. When non-zero, the tear PAA level was dissociated from gestation time and not different than non-pregnant and post-pregnant levels. The frequency of occurrence of zero level tear PAA increased with gestation: 16%, 17% and 46% had zero tear PAA in samples taken from women in the first, second and third trimester, respectively.ConclusionsOverall, of the tear samples taken from women during pregnancy, a total of 26% were at zero tear PAA. The remaining tear samples had non-zero tear PAA values throughout gestation equivalent to non-pregnant tear PAA values, suggesting local control of the source of PAA in tears. Given the importance of the plasminogen activator system in tears to wound healing in the cornea, and the high occurrence of zero tear PAA in our sample of pregnant women, elective corneal surgery would be contraindicated. If corneal surgery is nevertheless necessary, the tear PAA level would be worth checking and patients with low level should be closely observed during the postoperative period.

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“…Since the R124H mutation has also been described in clinically asymptomatic and “ dystrophy-free ” individuals prior to LASIK, who then develop deposition after LASIK [10, 11] suggesting this particular mutation and phenotype may be sensitive to/precipitated by/modified by trauma, genetic testing represents an important step especially in asymptomatic refractive surgery patients. Injury to the central cornea results in exacerbation of the GCD2 with dramatic acceleration of corneal deposition, opacities, and consequent visual loss.…”

Section: Discussionmentioning

confidence: 99%

Phenotypic Spectrum of Granular Corneal Dystrophy Type II in Two Italian Families Presenting an Unusual Granular Corneal Dystrophy Type I Clinical Appearance

Mazzotta

Traversi

Baiocchi

et al. 2015

Case Reports in Ophthalmological Medicine

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Clinical, instrumental, and genetic findings are reported in Italian families with Type II Granular Corneal Dystrophies (GCD2) presenting an initial unusual presentation of a Granular Corneal Dystrophy Type I (GCD1) phenotypic spectrum in female descendants. Slit-lamp examinations showed the typical phenotypic features of GCD2 in both mothers and a phenotypic appearance of GCD1 in both daughters. Despite the different phenotypic onset, the genetic diagnostic testing revealed the presence of a mutation in the TGFB-I gene, typical of GCD2 in both cases, excluding GCD1. Patients who were clinically suspected of corneal dystrophy need a genetic confirmatory testing for certain diagnosis. Genetic test may help to find the specific mutation distinguishing between different phenotypic spectra with relative diagnostic and prognostic implications. The study demonstrates that the phenotypic spectrum of genetically confirmed granular corneal dystrophies in patients may change over time. Since the R124H mutation has also been described in clinically asymptomatic individuals prior to LASIK, who then develop dramatic deposition, suggesting that this particular mutation and phenotype may be sensitive to, precipitated, or modified by central cornea trauma, a careful familial anamnesis excluding cornel dystrophies and specific preoperative genetic test are recommended prior to LASIK.

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Update on contraindications for laser-assisted in situ keratomileusis and photorefractive keratectomy

Cited by 44 publications

References 45 publications

Corneal Manifestations of Inflammatory Bowel Disease

Corneal Manifestations of Inflammatory Bowel Disease

Plasminogen activator activity in tears of pregnant women

Phenotypic Spectrum of Granular Corneal Dystrophy Type II in Two Italian Families Presenting an Unusual Granular Corneal Dystrophy Type I Clinical Appearance

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