Complications of Lasek and Epi-lasik
One of the most common problems or complications after lasek and Epi Lasik is pain which is more than that with lasik but still less than that after PRK ( photorefractive keratectomy ).
Pain can be reduced by bandage contact lens and applying topical and oral analgesic like NSAIDs.
Lasek Related Intra-operative Problems
1- Alcohol Related Complication
Alcohol leakage during surgery to the limbal and conjunctival area and in this case irrigation of these areas should be done immediately to prevent long term problems. This leakage can increase postoperative pain.
2- Incomplete Epithelial Separation
Due to insufficient alcohol exposure and poor surgical technique which will cause tearing of the flap fragmentations and creation of button holes. In patient with contact lenses wearer the alcohol should used for prolong time because the epithelial tends to be more adherent.
Additional application of alcohol can be sufficient to create a complete flap, if this fail the remaining epithelial can be scraped off and the procedure can be converted easily to PRK.
Epi Lasik Related Intra-operative Problems
1- Free or incomplete epithelial flap
2- Tearing and fragmentation of the flap
3- Buttonhole flap
Unlike in lasik, those remaining epithelium maybe removed mechanically and the procedure is converted to PRK.
Early Post-Operative Problems
1- Epithelial Healing
Complete healing in lasek is 3-5 days, similar to PRK. Delayed epithelial healing may occur in patients with dry eye incomplete closure of the eye and with some corneal diseases With prolonged use of bandage contact lens and frequent lubrication, the healing can be improved and accelerated.
2- Eye Pain
Post operative pain in lasek is less than PRK but is more than epi-lasik.Pain can be controlled by NSAIDs and bandage contact lens
3- Infiltration and infection
Mild form of sterile infiltration can occur and the exposure of alcohol more than 40 seconds is the predisposing factor. Topical NSAIDs will facilitate the resolution of it.
The incidence of infection is extremely rare and the treatment is culture of corneal swab and the application of antibiotics.
4- Dry eye
Dry eye can occur after them and treatments are with frequent lubrications and punctual plugs.
Long-term Post Operative complications of Lasek and Epi-lasik
1- Corneal haze
The incidence of this complication is increase with high refractive error which will lead to increase ablation depth.
Haze can be treated with phototherapeutic keratectomy or mechanical scraping with mitomycin C which is antimetabolic drug that prevent fibrosis.
This drug can be used in very low concentration fro 10-15 seconds as a prophylactic or as a treatment for haze.
2- Laser related complications
Such as under or over correction, decentration, glare, halos and regression.