Reasons for candidate exclusion in refractive surgery

Poster Details

First Author: R.Pinto PORTUGAL

Co Author(s):    F. Almeida   F. Fraga   M. Raposo   H. Filipe   A. Carvalho   J. Maia S

Abstract Details

Purpose:

To provide a statistical report of contra-indications for Refractive Surgery (RS) amongst individuals assessed as candidates for this type of procedure in our premises.

Setting:

Dr Gama Pinto Institute of Ophthalmology in Lisbon, Portugal

Methods:

This was a retrospective analysis which included 111 individuals (216 eyes) who were assessed as candidates for RS, namely Laser-Assisted In Situ Keratomileusis (LASIK); Phakic Intra-Ocular Lens (IOL) insertion; or clear lens surgery. Patients with a previous diagnosis of ectasic corneal disease were excluded, as were those previously submitted to corneal or intra-ocular surgery. For each RS candidate, the results of the standard screening tests were registered (complete study of refraction; keratometry; pupillometry; ultrasound pachymetry; keratic topography; and, when applicable, specular microscopy and biometry). For each excluded candidate, all intervening factors were recorded.

Results:

In our sample, 73.8% of the patients were female, mean age was 32.5 +/- 7.9 years, and mean absolute refractive error was 6.65 + /- 4.72 D. Based on age and refractive error, 61.3% of the individuals were considered for LASIK surgery, 37.8% for phakic IOL insertion and 4.5% for clear lens surgery. Overall, 56.7% of candidates for RS were excluded; these included 63.2% of those considered LASIK surgery, 45.2% of those assessed for phakic IOL insertion and 60.0% of those assessed for clear lens surgery. The most common reasons for candidate failure amongst those considered for LASIK surgery were: insufficient corneal thickness (23.2% of reasons); excessive pupillary diameter and lack of refractive stability (each one representing 16.1% of reasons for exclusion). The main reasons for exclusion amongst phakic IOL surgery candidates were insufficient anterior chamber depth (25.0% of reasons); low endothelial cell count and patient no-show at the appointed time for screening ((each one representing 15.0% of reasons for exclusion). In what regards clear lens procedures, the only grounds for candidate exclusion were low motivation for surgery on the patients“ behalf.

Conclusions:

If made available to the general public, this type of information can help to strenghten the notion of how strict the selection process for RS must be. This report also reveals a tendency for LASIK surgery to be the most frequently considered procedure, and for a low pachymetry to be the main reason for candidate failure in this context. On the other hand, this makes alternative techniques such as epi-LASIK and LASEK all the more attractive for these cases. FINANCIAL DISCLOSURE?: No