Laser eye surgery

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Visual defect

Complications

The most common complications arise during or after surgery - it is not feasible to list all of the possible predicaments. These complications often require a personalised approach and can normally be overcome or eliminated.

A - Complications during the surgery linked to the creation of the corneal flap

Extremely rare since the introduction of the Femtosecond laser.

1-Failure/loss of contact of the cone on the cornea
Re-put in place and therefore continued treatment.

2-Problem with the size or positioning of the flap
In this situation the following refractive treatment with the Excimer laser is not completed.
The surgery will be rescheduled for the following months and a new flap will be created.

B- Early post-operatoin complications

1-Displacement of the corneal flap
This is corrected by putting the flap back in place. This must be done with respects to safety.

2-Peices of cornea or other material under the flap
Small particles of the cut cornea can sometimes slide under the flap at the end of the operation; they are negligible and do not affect vision, as such they can be ignored or removed by rinsing the eye.

3-Inflammatory reaction or Diffuse Lamellar Keratitis
According to the severity, this can be treated with special eye drops or by removing the membrane and rinsing the affected area.

4-Corneal infection
An exceptional situation as surgery is conducted in a dedicated operating room which respects the sanitation standards and protocols. _ Treatment with antibiotics.

5-Wearing or epithelial defect
Much less likely since the introduction of the Femtosecond laser and more common in older patients. A fragile epithelium can become detached and rub causing various different degrees of irritation or pain. _ This can be treated by wearing a therapeutic contact lens.

6-Ocular dryness
This is quite common and normally fixes itself over a few months, the treatment is to use hydrating, lubricant eye drops or even to implant a lacrimal insert to regulate hydration.

7- Halos in the evening light, glare
Seeing halos or experiencing glare in dim or evening light is often a temporary reaction to surgery. These complications are less frequent since the introduction of the latest generation Excimer lasers.

In the case of serious discomfort it is possible to re-treat the eye following analysis of the corneal aberrations using wavefront technology.

8-Sensitivity to light
A temporary reaction that will subside with time.

9-Visual variations
These are common but rarely severe and vision will stabilise quickly.

C- Long term post operation complications

1-Under correction
Not an actual complication but a possible outcome when performing large optical corrections.

In the case of serious visual inconvenience a « refractive re-touch » can be performed by re-lifting the corneal flap. This takes place following an examination of the cornea to ensure that its condition and thickness are of suitable quality.

2-Over correction
Even more unlikely and the same procedures apply as for the under correction.

3-Regression
Continued reduction in visual sharpness after surgery is often due to scarring of the cornea and is more common following strong corrective surgery.
The treatment involves further surgery following examination of the cornea.

4-Corneal opaqueness or « haze »
After LASEK surgery, there is usually an inflammatory reaction of the cornea, due to the contact with the Excimer laser. This reaction does not compromise vision and can be treated with anti-inflammatory eye drops.

However, severe reaction can cause an opaqueness or haze and in this case further surgery will be required. The risk of haze increases with the strength of the myopia that is treated.

5-Epithelial Invasion
This complication is due to the passage of the corneal epithelial cells under the corneal flap. Normally it is a micro invasion which takes place at the edge of the flap; this will subside and does not affect the sharpness of vision or the adherence of the flap to the underlying stroma.

The risks are linked to the growth and expansion of these cells which can lead to the thinning down of the corneal flap causing astigmatism and a decline in vision. The treatment depends on the progression of the epithelial invasion and whether or not they are affecting the stability of the corneal flap.
In this situation it is prudent to undergo further surgery to remove the responsible cells.

6-Corneal ectasia
This is a very rare progressive complaint following LASIK surgery. It is a decline in vision linked to an increasing corneal curvature. This complication can be caused by a severe thinning of the cornea after surgery.

The treatment is foremost preventative, and relies on the preoperative examinations.

This in depth assessment is designed to detect irregular or exceptionally thin corneas which might be susceptible to imperfect pathology following LASIK.
These corneas are said to be too risky and are not operated on. _ However, despite these preoperative precautions this complaint still exists.

The treatment, as a last resort consists of a corneal graft to improve vision.

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