Dr. Weinstock is a board-certified ophthalmologist. He practices general ophthalmology in Canton, Ohio, with a special interest in contact lenses. He holds faculty positions of Professor of Ophthalmology at the Northeastern Ohio Colleges of Medicine and Affiliate Clinical Professor in the Charles E. Schmidt College of Biomedical Science at Florida Atlantic University.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
As with any surgical procedure, complications may occur. In laser vision corrections, complications may occur during the procedure (intraoperatively) or during the healing period following the procedure (postoperatively).
Your ophthalmologist should discuss the possible risks before the procedure so that you understand the procedure and that any concerns you may have can be addressed.
Complications during the procedure mainly occur during the creation of the flap with the microkeratome. These include incomplete flaps, irregular or small flaps, buttonholes, decentered flaps, free flaps, or penetration of the eye. When these complications occur during surgery, the procedure is stopped, and the flap is put back in place. The flap is then allowed to heal for
three to six months. After this healing period, the procedure may be repeated and the flap may be recut.
In some procedures, with a very thin cornea, it is possible to cut through the cornea into the eye. In this situation, the operation is also halted until healing takes place. During this time, you must be carefully monitored to make sure that a serious infection does not occur.
Early complications after the procedure include dislodged flaps and flap folds. Folds can be described as macrofolds and microfolds, which can cause visual distortion. Dislodged flaps and macrofolds require that the flap be lifted and repositioned, thus eliminating the folds.
Other complications include interface debris (debris between the flap and the lasered cornea), epithelial downgrowth into the flap, epithelial defects, or corneal abrasions.
Infection of the cornea (infectious keratitis) and inflammation can also occur. Infections are rare but very serious if they do occur.
Refractive complications include undercorrections or overcorrections, which may require additional laser correction (an enhancement procedure) and decentered laser ablation, which may require retreatment or the use of a hard contact lens.
Laser vision correction could also induce astigmatism. Halos and glare, especially at night, may occur after the procedure. They are common after the procedure but usually go away, but they sometimes can permanently affect the quality of vision.
Regression of the procedure may occur and would require additional laser treatment or the use of glasses or contact lenses, especially in cases with higher astigmatism and hyperopia.
After the surgery, dry eye symptoms are the most common complaint. Dry eyes following LASIK may occur due to a decrease in corneal sensation because the microkeratome cuts through the superficial corneal nerves. This may result in a decreased blink rate and, thus, a decrease in rewetting of the eye. Most people notice an improvement with the use of artificial tear lubrication and with time. Occasionally, a patient will need to be treated with punctal plugs to alleviate the dry eye symptoms.
Diffuse lamellar keratitis is an inflammatory condition that can occur with the LASIK procedure. Its cause is unknown. It occurs in about 0.2% of LASIK procedures. If this condition is recognized and treated promptly, it usually resolves without further complications. Left untreated, it can cause a loss of vision.