Importance of reporting the complicationsof refractive surgery

from

the

editor

Importance of reporting the complications of refractive surgery orneal and intraocular surgery to correct refractive errors of the human eye has now gained worldwide popularity. The results of surgery are continuously improving, with either new or refined techniques or new or refined instruments. Recently, new standards for reporting refractive surgical results have been described) The main purpose of these standards is to facilitate the comparison of studies and improve the quality of procedures. The components required by the new standards are safety, efficacy, predictability, stability, reversibility, and complications. In this issue, 2 complications of refractive surgery are presented. Both cases provoke comments. 1. The Consultation Section describes a patient who is very dissatisfied with the results of incisional refractive surgery for hyperopia. This patient was referred to a physician, and the preoperative history was not known. The patient was overcorrected, which migh~ have been manifest immediately preoperatively or might have developed as myopic shift over time, and after 5 years is a candidate for refractive surgery. In addition, it appears that he lost best corrected visual acuity (BCVA) in the'operated eye; the problem might not be correctable. Loss of BCVA after a refractive procedure requires our ongoing attention. Intraoperative and short-term complications are frequently reported in the literature, but this case clearly demonstrates how important it is to evaluate refractive surgery over a long period. We tend not to follow patients in a systematic way once a technique has been accompanied or even replaced by other procedures. The patient, however, has to be informed about long-term results, and the physician should be able to change the treatment based on outcome over time.

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Therefore, long-term follow-up of every refractive procedure is highly desirable, and we will all benefit from peer-reviewed data. 2. An almost complete loss of central vision 21/2 months after photorefractive keratectomy (PRK) for low myopia is reported by Mailing. A 30-year-old man had acute keratitis after PRK with contact lens placement and no prophylactic antibiotic treatment for 2 days. Obviously, the patient's postoperative treatment was not well controlled and more sophisticated knowledge about an appropriate pharmacological regimen in patients whose epithelium has been removed might have prevented a severe complication after elective refractive surgery for 3.75 diopters of myopia. We can all learn from this case and have a responsibility to continually educate ourselves about rapidly developing refractive techniques. These examples of unsatisfactory outcomes after refractive surgery remind us of the preoperative and postoperative care we must give to patients and also of the seriousness with which we should evaluate (both short- and long-term), select, and perform refractive procedures to minimize the risk to patients. As refractive surgery develops, the reporting of all complications of refractive procedures--nonsight-threatening as well as sight-threatening--becomes increasingly important for all of us.

Thoma2 Kohnen, MD Reference

1. Koch DD, Kohnen T, Obstbaum SA, Rosen ES. Format for reporting refractive surgical data (editorial). J Cataract Refract Surg 1998; 24:285-287

J CATARACT REFRACT SURG--VOL 25, JANUARY 1999

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