Corneal refractive surgery (LASIK) poses a risk to the glaucoma patient

The Science behind the Tip

The transient, yet significant, IOP elevation caused by the suction ring may further damage an already compromised optic nerve (1). The resultant corneal changes which induce an underestimation in IOP measurement, coupled with post-treatment topical steroid use, further adds to the glaucomatologist?s anxiety (2). Steroid-induced IOP elevation may remain undetected if pressure-induced lamellar keratitis develops, as this further falsely lowers IOP measurement (3).

Surface ablation procedures may be a better choice if combined with prophylactic MMC to modulate the need for long term post-treatment topical steroids (4). However, ocular surface disorders secondary to the chronic use of topical hypotensives may lead to longer recovery times.

Although not an absolute contraindication, glaucoma is a relative contraindication to LASIK. Each patient should be considered on an individual basis, with the glaucomatologist and refractive surgeon working closely together.

Contributor: Aachall Kotecha, Moorfields Eye Hospital, London

References:

1. Shrivastava, A., Madu A, Schultz J, Refractive surgery and the glaucoma patient. Curr Opin Ophthalmol, 2011. 22(4): 215-21.

2. Bower, K.S. , Woreta F, Update on contraindications for laser-assisted in situ keratomileusis and photorefractive keratectomy. Curr Opin Ophthalmol, 2014. 25(4): 251-7.

3. Hamilton, D.R., et al., Steroid-induced glaucoma after laser in situ keratomileusis associated with interface fluid. Ophthalmology, 2002. 109(4): p. 659-65.

4. Teus M.A., de Benito-Llopis L, and Alio JL, Mitomycin C in corneal refractive surgery. Surv Ophthalmol, 2009. 54(4): p. 487-502.

Tip Reviewer: Roger Hitchings
Tip Editors: John Salmon and Gordana Sunaric Mégevand