Chapter 4- Complications of Advanced Surface Ablation

1. Haze of the cornea can occur after Advanced Surface Ablation. It occurs more in higher levels of nearsightedness (over -8.00 diopters). With nearsightedness over -8.00 diopters, treatment with Mitomycin C is advised. This is applied for 2 minutes on the cornea with a sponge after the laser treatment. The eye is then irrigated. Another method to avoid haze is to cool the contact lens and drops used, in ice. Cold solutions and cold drops help avoid haze.

2. Infection is always a concern following eye surgery. Zymar (Gatifloxacin), a potent 4^th generation fluoroquinolone antibiotic is used 2 days before surgery and until the contact lens is removed. The eyelid is scrubbed with Betadine preoperatively to kill bacteria.

3. The epithelium may not heal down properly. This frequently is due to dry eyes. Dry eye treatment consists of providing extra moisture for the eye. If dry eye is recognized before laser treatment, dry eye treatment is carried out. (See dry-eye chapter 7)

4. The treatment ablation may be decentered. This condition can occur with both LASIK and Advanced Surface Ablation. The newer Excimer lasers have pupil trackers which align the center of the pupil during the treatment. This complication should be a complication of the past. With wavescan treatment parameters, decentered ablations can be treated with the newer algorithms.

5. The incidence of night glare and halos are reduced with the newer Excimer lasers treatments, whose treatment zones extend to 8 mm. Some patients with a pupil size in the dark of eight or more millimeters are not good candidates for laser surgery.

References

Buratto,L. and Brint, S.: Custom LASIK: Surgical Techniques and Complications. Thorofare, N.J.Slack. 2003 p161-287. [book]

Linebarger EJ, Hardten DR, Lindstrom RL. Diffuse lamellar keratitis: diagnosis and management. J. Cataract Refract Surg. 2000; 26: 1072-1077. [pubmed]

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