Chapter 5- Pre-operative Workup Part I

The pre-operative examination is the same for all refractive surgeries. It should include the following:

• General medical history
• Ocular history
• Examination of the ocular adnexa
• Anterior segment slit lamp examination
• Quantitative and qualitative evaluations of lacrimal function, especially with a history of dry eye syndrome
• Contact lens history
• Evaluation of blink reflex
• Dilated fundus examination
• Intraocular pressure
• Computerized corneal topography
• Visual acuity
• Manifest and cycloplegic refraction
• Biometry
• Pupil diameter
• Pachymetry (measuring the corneal thickness)
• Determination of the dominant eye
• Wavefront measurements

The following conditions should be evaluated.

• Diabetes-well controlled diabetics are better candidates than insulin dependent and poorly controlled diabetes. Diabetes is a relative contraindication.
• Pregnancy/ breast feeding- both conditions are a contraindication to laser surgery. The patient should wait at least six weeks following delivery and breast feeding before having laser surgery.
• Autoimmune/connective tissue diseases such as rheumatoid arthritis, systemic lupus erythematosis, scleroderma and nodular panarteritis are contraindications to Excimer laser treatment. Wound healing is unpredictable with these disorders.
• Immunodepressed patients are at a higher risk for infection and therefore are a relative contraindication for Excimer laser treatment.
• Systemic infections such as HIV and tuberculosis are relative contraindications for Excimer laser surgery.
• Previous eye surgery such as retinal detachment, vitrectomy, cataract and glaucoma surgery need to be individually assessed as to the appropriate treatment.
• Cataract is the clouding of the natural crystalline lens. The removal of the lens and placement of an intraocular lens should be considered instead of refractive surgery for older patients with cataract. The surgeon aims to reduce or alleviate the need for glasses after the cataract surgery.

References

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

Mrochen M et al.. Increased higher-order optical aberrations after laser refractive surgery: a problem of subclinical decentration. J Cataract Refract Surg 2001 Mar; 27 (3): 362-369. [pubmed]

Schwiegerling J, Snyder RWl Corneal ablation patterns to correct for Spherical aberration in photorefractive keratectomy. J. Cataract Refract Surg 2000 Feb; 26(2): 214-221. [pubmed]

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