home Audience 6 Complications after laser vision correction using the lasik method. Laser vision correction. Consequences. Reviews. Risk. Decentration of the optical zone of laser ablation

Complications after laser vision correction using the lasik method. Laser vision correction. Consequences. Reviews. Risk. Decentration of the optical zone of laser ablation

Negative consequences of laser vision correction (we are primarily interested in complications) are extremely rare. However, problems sometimes happen, and each eye disease is different. Therefore, it is important to understand their specifics.

Nowadays, millions of people are dissatisfied with the imperfection of their vision, some have myopia, others have farsightedness, and sometimes also astigmatism. To correct all these imperfections, simply wearing glasses or contacts is not enough, so many turn to laser correction for help, often without thinking about the consequences.

Note! "Before you start reading the article, find out how Albina Guryeva was able to overcome problems with her vision by using...

When is laser correction needed?

First, let's take a closer look at those common eye diseases that may require laser vision correction.

Myopia

This pathology (scientifically called myopia) occurs when the eyeball is deformed - it is stretched. In this case, the focus shifts from the retina to the lens, and the person sees objects blurred.

The difference in the location of the focus and the structure of the eye with normal vision, myopia and farsightedness

Farsightedness

Farsightedness or hypermetropia appears due to the reduction of the eyeball, while the focus of objects closest to a person is formed behind the retina, as a result of which a person sees these objects blurred.

Astigmatism

This disease is more complex than myopia or hypermetropia, and can be observed in both the first and second cases. It occurs when the cornea of the eye and sometimes the lens are abnormally shaped. In normal people, the cornea and lens have a regular spherical shape, but with astigmatism, their shape is disrupted. At the same time, when a person looks at objects, the focus is either behind the retina or in front of it, as a result of which he sees some lines clearly, but not others, and the image turns out blurry.

eyes with normal vision and with astigmatism

What is laser vision correction?

Most often, doctors advise correcting these pathologies with the help of glasses and lenses, but there are alternative ways to combat them, not least of which is laser correction. At the moment, this is the most effective and popular way to treat these ailments.
In 1949, Colombian doctor José Barracuer found a way to correct vision using a laser. And in 1985, the first operation with an excimer laser was already performed. In simple words, laser correction is an operational intervention, the purpose of which is to change the cornea of the eye. Today there are two main methods of laser correction - PRK and Lasik, and several improved methods based on the Lasik system. Now let's look at each of these methods in detail.

Photorefractive keratectomy (PRK)

PRK is the very first laser surgery. With this method, there is a direct effect on the upper layer of the cornea. Using a laser, the specialist removes the surface layer of the cornea, then with a cold ultraviolet ray he corrects it to the desired size, calculated using a computer, so that the focus of the image is on the retina. So, in case of myopia, the cornea is made flatter, in case of farsightedness, it is made more convex, and in case of astigmatism, the cornea is corrected to the shape of a regular sphere. Restoration of the upper epithelial layer after surgery occurs in three to four days, this occurs with slight discomfort for the eye. After three to four weeks, vision is restored.

Advantages of the technique:

non-contact exposure;
painlessness;
short duration of the operation;
stability in the forecast of results;
high quality of vision is achieved;
low likelihood of complications;
possibility of carrying out with a thin cornea.

Disadvantages of the technique:

duration of recovery;
discomfort in the eye during recovery;
temporary deterioration in the transparency of the corneal surface (Hayes);
impossibility of simultaneous correction in both eyes.

Lasik

The operation using Lasik technology occurs as follows: the surface layer of the cornea (corneal flap) is separated with an instrument or a special solution, and after correction it is put back on the surface. Within a couple of hours after the operation, the epithelial layer is completely restored. And vision returns after seven, and sometimes after four days.

The Lasik technique is divided into several more techniques: the Lasik technique itself, super Lasik, femto Lasik and femto super Lasik.

These techniques differ from each other in the way the corneal epithelium is separated at the first stage of the operation, as well as in the use of more advanced computerized equipment, which allows complications after surgery to be minimized.

Classic Lasik

This operation uses a “cold” ultraviolet beam from an excimer laser, which changes the optical power of the cornea. Thanks to this change, it is possible to completely focus the light rays on the retina, which is what is needed to restore visual acuity. Thus, for patients with myopia, the Lasik technique allows them to correct the steep shape of the cornea, making it quite flat. For patients with farsightedness, on the contrary, it corrects the shape of the cornea to a steeper one.

Advantages of the technique:

fast recovery;
preservation of the epithelial layer of the cornea;
painlessness;
no complications during the recovery period;
possibility of operating on both eyes at the same time.

Disadvantages of the technique:

high risk of intraoperative complications (bleeding);
discomfort in the eye after surgery (passes quickly);
impossibility of use with a thin cornea;
in the absence of a strong connection between the corneal layer and the cornea, optical distortions may occur;
risk of dry eye syndrome (recovers after a year);
the need to instill medicine into the eyes for 10-14 days.

Super Lasik

The Super Lasik technique allows for a more individual approach to each case using high-tech diagnostic equipment - the Wave Scan wave analyzer system. Using this equipment, a specialist can find out the dimensions of all components of the visual apparatus and accurately record all deviations of the visual system of the person being operated on.

Advantages of the technique:

achieving high results up to 100%;
fast rehabilitation;
the ability to correct deficiencies obtained during earlier operations.

Disadvantages of the technique:

complications due to mechanical effects on the cornea;
the possibility of dry eye syndrome;
sometimes the depth of impact on the cornea is greater than with regular Lasik.

Femto Lasik

The Femto Lasik technique eliminates the use of mechanical instruments to obtain a corneal flap, as with the Lasik technique. The specialist sets the necessary parameters, and a computer system, including a high-precision femtosecond laser, separates a horn-like flap of a given thickness. Then everything happens the same as during Lasik surgery.

Advantages of the technique:

possibility of surgery for thin corneas;
high stability of results;
fast rehabilitation.

Disadvantages of the technique:

more time to work with a corneal flap and, as a result, prolongation of the entire process;
the need for strict fixation of the eye, which can affect the eyeball;
the cost is twice as high as conventional Lasik surgery.

Femto Super Lasik

The Femto Super Lasik technique involves the use of a Wave Scan analyzer and a femtosecond laser. This allows you to obtain a corneal flap in a non-contact manner and take into account all the individual characteristics of the eye of the particular person being operated on at the moment.

Advantages of the technique:

fast operation;
individual approach for each specific patient;
achieving high results;
fast rehabilitation;
no mechanical impact;
Possibility of surgery for thin corneas.

Disadvantages of the technique:

high price.

Complications after laser vision correction

Although laser correction is a completely painless and outpatient operation and the risk of possible adverse effects is minimized, it is still an operation and the patient who wants to use it for vision correction needs to be aware of the possible complications. Here are some consequences of laser vision correction:

complications due to low-quality equipment or an unqualified specialist;
disorders that may appear in the postoperative period;
inflammation after surgery;
swelling, redness, discomfort in the eye;
unsatisfactory result of the operation (the eye disease was not completely cured, etc.);
long-term consequences (the possibility of the disease returning several years after surgery);
possibility of vision impairment;
the likelihood of corneal clouding.

Let's look at some of the consequences of complications in more detail.

Complications due to poor-quality equipment or an unqualified specialist

Sometimes, due to some technical reasons or due to the insufficient level of qualifications of the doctor, some complications are possible during the operation itself. For example, the parameters for the operation may be incorrectly selected, a loss of vacuum may occur, and the corneal flap may be cut incorrectly. All these reasons can lead to clouding of the cornea of the eye, the appearance of irregular astigmatism, and double vision. Such complications account for approximately 27% of all operations.

Disorders that appear in the postoperative period

Complications during this period include inflammation and swelling of the eye, retinal rejection, hemorrhages, and discomfort in the eyes. The reason for such complications is the individuality of each organism and its ability to quickly recover after surgery. Such complications account for approximately 2%. To get rid of them you will have to undergo long-term treatment or undergo repeated surgery, and sometimes this does not help to fully recover.

Unsatisfactory result of the operation

Sometimes the operation is not completely justified and we do not get the desired result. For example, after laser correction, residual myopia may occur. In this case, a repeat operation is needed in one to two months. If you get a plus from a minus, or vice versa, you also need a repeat operation, but after two to three months.

Long-term consequences

Sometimes so-called long-term consequences occur, which occur three or more years after the operation. Unfortunately, in many cases, the correction does not completely get rid of the disease, and it may return in the future. Experts have not determined why these complications occur, because of the operation itself or because of the characteristics of the person’s body, or perhaps because of his lifestyle. But even after repeated surgery, success is not guaranteed.

Contraindications for laser correction

Laser vision correction cannot be performed:

pregnant women;
during breastfeeding;
patients under 18 years of age;
people with diabetes (and in general with diseases that may cause poor healing);
with immunity disorders;
for eye diseases such as: thinning of the cornea (keratoconus disease), retinal detachment, cataracts, glaucoma.

Restrictions and necessary actions of the patient after laser correction

To avoid complications after surgery, you must strictly follow the doctor’s advice:

during the rehabilitation period, try to sleep on your back;
do not use cosmetics on the face, especially the eyes;
limit washing your face and head for 3-4 days after surgery;
spend less time watching TV, computer, reading;
do not visit public bodies of water;
wear dark glasses in bright sunshine;
do not drink alcoholic beverages for one week after surgery;
do not drive in the dark;
do not rub your eyes;
try to avoid physical activity;
apply eye drops prescribed by a specialist strictly in time and the required number of times;
be examined by a doctor at the appointed time.

Much has been said about its benefits, but the possible complications are not often covered. After LASIK, complications of one kind or another of varying severity are observed in approximately 5% of cases. Serious consequences that significantly reduce visual acuity occur in less than 1% of cases. Most of them can only be eliminated through additional treatment or surgery.

The operation is performed using an excimer laser. It allows you to correct astigmatism up to 3 diopters (, or ). It can also be used to correct up to 15 diopters and up to 4 diopters.

The surgeon uses a microkeratome tool to cut the top of the cornea. This is the so-called “flap”. One end remains attached to the cornea. The flap is turned to the side and access to the middle layer of the cornea is opened.

The laser then evaporates a microscopic portion of the tissue in this layer. This is how a new, more “correct” shape of the cornea is formed so that the light rays are focused precisely on the retina. This improves the patient's vision.

The procedure is fully computer controlled, fast and painless. Once completed, the flap is returned to its place. In a few minutes it adheres firmly and no stitches are required.

Consequences of LASIK

The most common (about 5% of cases) are the consequences of LASIK, which complicate or lengthen the recovery period, but do not significantly affect vision. They can be called side effects. They are usually part of the normal post-operative recovery process.

As a rule, they are temporary and are observed for 6-12 months after surgery while the corneal flap is healing. However, in some cases they can become a permanent occurrence and create some discomfort.

Side effects that do not cause a decrease in visual acuity include:

Deterioration of night vision. One of the consequences of LASIK may be deterioration of vision in low light conditions, such as dim light, rain, snow, fog. This deterioration may become permanent, and patients with dilated pupils are at greater risk of this effect.
Moderate pain, discomfort, and a feeling of a foreign object in the eye may be felt for several days after surgery.
Watery eyes usually occur within the first 72 hours after surgery.
Dry eye syndrome is an eye irritation associated with drying of the corneal surface after LASIK. This symptom is temporary, often more severe in patients who have suffered from it before surgery, but in some cases it can become permanent. Requires regular moistening of the cornea with artificial tear drops.
Blurred or double images are most often observed within 72 hours after surgery, but can also occur in the late postoperative period.
Glare and increased sensitivity to bright light are most noticeable in the first 48 hours after correction, although increased sensitivity to light may persist for a long time. The eyes may become more sensitive to bright light than they were before surgery. Driving at night may be difficult.
Ingrowth of the epithelium under the corneal flap is usually observed in the first few weeks after correction and occurs as a result of a loose fit of the flap. In most cases, ingrowth of epithelial cells does not progress and does not cause discomfort or visual impairment for the patient.
In rare cases (1-2% of all LASIK procedures), epithelial ingrowth can progress and lead to flap elevation, which negatively affects vision. The complication is eliminated by performing an additional operation, during which overgrown epithelial cells are removed.
Ptosis or drooping of the upper eyelid is a rare complication after LASIK and usually goes away on its own within a few months after surgery.

A number of LASIK complications cause decreased visual acuity. To eliminate them, repeated correction will be required.

These include:

LASIK complications that can lead to significant vision loss are extremely rare. These consequences are:

Damage or loss of the flap in the patient as a result of trauma during the first month after surgery.
Diffuse lamellar keratitis - the causes of its occurrence are unknown. Treatment must be started as early as possible, otherwise clouding of the cornea will develop, which will lead to partial loss of vision.

It must be remembered that LASIK is an irreversible procedure that has its own risks. It involves changing the shape of the cornea of the eye, and after it is performed, it is impossible to return vision to its original state.

If the correction results in complications or dissatisfaction with the result, the patient's ability to improve vision is limited. In some cases, repeated laser correction or other operations will be required.

Unpleasant consequences of laser vision correction are possible, despite the speed, painlessness and accuracy of the procedure. They can occur both due to incorrect manipulations during the operation process itself, and due to non-compliance with medical recommendations in the postoperative period. Correction of such complications is real, but no ophthalmologist can ever give a 100% guarantee.

The use of laser techniques for vision correction is not a medical procedure. These are corrective manipulations that make it possible to eliminate the consequences of eye diseases, restoring vigilance, but not to treat the disease itself.

The use of such correction is recommended for severe myopia or farsightedness, sometimes complicated by astigmatism. A similar restorative technique is recommended for people who, due to professional factors or the individual structure of their visual organs, are not able to wear glasses or contacts. A person with a large difference in diopters in different eyes can also undergo correction in order to avoid constant overwork of one of them.

Before the procedure, the patient must undergo certain preparation.

This may include:

full examination to identify contraindications;
checking visual acuity immediately before manipulation;
application of anesthetic drops immediately afterwards.

During the day before the procedure, you should not use decorative cosmetics or drink alcohol.

During the operation, a laser is used to target certain areas of the cornea, changing its shape. Many correction methods have currently been developed, for example, PRK, Lasik, Lasek, Epi-Lasik, Super-Lasik, Femtolasik. The first of them is a laser effect on the surface of the cornea in order to strengthen it and restore vision. The return of vigilance occurs gradually over the course of a month. Lasik techniques involve affecting the deep corneal layers, and vision returns to normal faster.

Not everyone is allowed to correct imperfections in their eyes.

This cannot be done:

minors (sometimes young people under 25 years of age);
those over forty to forty-five years old;
pregnant and nursing mothers;
in the presence of keratoconus;
people with certain immune system or metabolic dysfunctions;
for serious eye diseases.

Correction is not carried out during periods of exacerbation of any chronic ailments. If contraindications are neglected, the risk of side effects can greatly increase.

During the operation, a failure may occur, most often caused by technical reasons or insufficient professionalism of the doctor.

Risk factors for such problems include:

Incorrect indicators entered into the computer.
Incorrectly selected tools.
Lack or interruption of vacuum supply.
The cut is too thin or split.

This or that complication can lead to clouding of the cornea, astigmatism, monocular double vision, and decreased vigilance. According to statistics, unpleasant consequences occur in 27 percent of cases.

Postoperative side effects

After laser vision correction, the operated organ becomes fragile and vulnerable. Any, even the smallest damage can lead to serious consequences, including blindness. It is very important for those undergoing the procedure to follow all the doctor’s recommendations.

Prohibitions may include:

touching the operated eye within 24 hours, rubbing it for at least three months after surgery;
washing and washing your hair for 72 hours after laser vision correction;
drinking alcohol while taking antibiotics;
heavy physical work, professional sports for 90 days after eye surgery;
swimming, sunbathing and applying decorative cosmetics for a similar time;
driving at dusk and at night for approximately two months after the procedure due to a temporary decrease in contrast sensitivity.

During the postoperative period, clinic clients sometimes complain about the appearance of stars or circles in the eyes, as well as dry vision.

Also after laser vision correction you may experience:

swelling,
retinal rejection,
conjunctivitis,
epithelial ingrowth,
hemorrhages,
sensation of a foreign object in the eyes.

Such side effects do not occur due to low qualifications of the doctor or malfunctioning devices. Such complications are caused by the body’s individual reaction to surgery. In some cases, they go away after a rehabilitation period, but sometimes additional treatment is required.

Another type of complication is called undercorrection, when instead of one result another is obtained. For example, vision decreases in the form of residual myopia. Or instead of myopia, a person develops farsightedness. This will require repeated correction after a period of one to three months.

Long-term consequences of surgery

Complications can appear long after laser vision correction. Such long-term troubles pose the greatest danger to health.

Correction removes the consequences of eye diseases that lead to decreased vision. But she is unable to eliminate the causes of these ailments. In this case, as the disease progresses, vision may deteriorate after laser correction after several years. True, it will be difficult to say whether this is due to hidden problems during the operation or the patient’s lifestyle.

Each of the following problems may appear months after the procedure:

disappearance of the positive effect of laser intervention;
thinning of the tissues affected by the device;
clouding of the corneal layer;
development of eye diseases that did not exist before.

To prevent the operated patient’s vision from subsequently deteriorating, he must lead a healthy lifestyle, say goodbye to bad habits, avoid excessive physical or visual stress, and follow other doctor’s instructions.

If a person feels that his vision is deteriorating after correction, he should immediately consult an ophthalmologist.

Of course, problems after eye surgery can be eliminated. But there is no absolute guarantee that after the new correction everything will get better. Although doctors can still predict the chances.

They divide all complications after laser vision correction into three large subgroups:

If there are no vital indications for eye surgery, it is better not to perform it. Then you won’t have to deal with complications after laser vision correction. But if correction is necessary, you should choose a trusted clinic and a doctor who has performed many successful operations.

Vision restoration techniques

help yourself

Laser correction. Consequences.

This page collects information one way or another related to the consequences of laser vision correction. Information different from what can be found in tempting advertising. The goal is for you to have more or less objective information about the possible consequences of laser vision correction, so that you think about the risks.

Note: all the clinics mentioned, if not specified, are located in Minsk.

e-mail correspondence, 2006:

Good afternoon!

Katerina

Thank you! :)

What was the name of the operation (lasik or another)?
- I read that before and after the operation there are some instructions - such as not wearing lenses, etc. - did you follow all of them?
- are there any negative aspects of this operation (except for the fact that everything came back over time)?
- haven’t you tried to restore it with exercises?

I don’t remember the name, I was 17 years old, somehow I didn’t remember it :)
Of course, there were instructions, of course, she followed them. There are also a lot of vitamins and procedures.
Apart from the fact that it didn’t work out, there are no other negative aspects, the operation was painless and there were no unpleasant sensations afterwards
I haven’t tried it, I take herbal supplements with blueberries - it helps much better;))

Katerina

e-mail correspondence, 2006:

communication at a corporate forum, 2003:

And here are reviews and comments about laser vision correction from the “Dialogues” section of the forum.

Here's another article. Unfortunately, the source is unknown, found on one of the Internet forums.

The main disadvantages of laser vision correction

There are many of them in laser vision correction, so many that even the founding fathers of this method no longer recommend it for widespread use. For example, in the reports at the conference on refractive surgery in 2000, such founders of the method as Theo Sailer (director of the eye clinic of the University of Zurich, Switzerland), Yanis Pallikaris (director of the eye clinic, Greece, inventor of the LASIK method), Maria Tassinho ( professor at the University of Antwern, Belgium), and others, more than 30 possible complications were noted that accompany the most popular laser surgeries today, the LASIK method. In these reports, there was clear concern not only about possible surgical and postoperative complications, which at the very least, to one degree or another, can be eliminated, but also about the possible loss of quality of vision, which cannot be further corrected by sphero-cylindrical optics.

The observations of ophthalmologists in Russia are fully consistent with world data. Thus, in the report of Russian scientists K.B. Pershin and N.F. Pashinov “Complications of LASIK: analysis of 12,500 operations”, made at the conference “Modern Medical Technologies” in Moscow, it is argued that when analyzing the structure and frequency of complications of laser vision correction operations based on 12,500 operations performed in Excimer clinics in the cities of Moscow, St. Petersburg, Novosibirsk and Kiev, over the period from July 1998 to March 2000, it was discovered that complications, deviations from the normal course and side effects of LASIK are noted in 18,61% cases! These operations were performed by leading Russian surgeons with significant experience and professional skills, using modern NIDEK TC 5000 excimer laser systems. At the same time, in 12,8% In some cases, repeated operations were required to correct these defects.

We list only the main types of complications with laser vision correction:

Surgical complications. They are associated, first of all, with the technical support of the operation and the skill of the surgeon: loss of vacuum or its insufficiency, incorrectly selected parameters of vacuum rings and stoppers, thin section, split section, and much more. The share of such surgical complications, according to the article cited above, is 27% of the total number of operations. At the same time, complications that worsen visual function and affect long-term results are 0.15%, which can be expressed in a decrease in maximum visual acuity, monocular double vision, induced astigmatism and irregular astigmatism, as well as corneal opacification. It seems that 0.15% is quite a bit, but imagine that it was you who ended up among these several dozen unfortunate people. What exactly is your cornea clouded, and in the very center of the eye, which is functionally the most important. You see this perfectly in the morning and poorly in the evening, and this is exactly what you see in the twilight, or, conversely, in bright low beams, due to reflection from possible small scars, flashes, rings of light, double vision appear in the eye, and besides, all this happens, when you drive a car. So is it worth the risk? Maybe it would be better to just wear glasses, which, by the way, are very easy to remove, as opposed to irreversible surgical interventions on the cornea?

Postoperative complications. In modern refractive surgery, this group of complications includes a large number of conditions: from inflammatory reactions to subjective patient dissatisfaction with the result of the operation. These conditions (inflammation, swelling, conjunctivitis, epithelial ingrowth, “sand in the eye” syndrome, hemorrhages, retinal detachment, binocular vision disturbances and much more) occur in the next few days after surgery and do not depend on the skill of the surgeon and the laser technology used, but associated with individual characteristics of postoperative healing. The frequency of such complications, which includes corneal opacity, according to various sources, averages 2% of the number of operations. All of these painful conditions require long-term treatment with the use of expensive medications, and often additional operations on an already weakened cornea. Moreover, not all of these events always lead to success and full recovery.

Complications associated with ablation. This, the largest group of complications during laser vision correction, is due to the fact that often the refractive result from the operation is not what was expected. The most likely undercorrection is residual myopia. It is detected immediately after surgery. In this case, you will need additional surgery in 1-2 months. If, on the contrary, they “overdid it” and turned a “minus” into a “plus” or vice versa, then a second correction is carried out after 2-3 months. Again, it is not necessary that the second operation will be more successful than the first. And the ability of the eye to perceive successive operations one after another is far from unlimited.

Long-term consequences of laser vision correction. This is the most subtle and completely unexplored problem. In the same time, It is the long-term consequences of laser vision correction operations that can pose the greatest danger to humans. The fact is that laser correction does not cure myopia, farsightedness and astigmatism as such, because These are systemic diseases of the entire organ of vision with damage to the retina, sclera and structures of the anterior part of the eye, caused by certain biological and genetic reasons in the human body. The operation only corrects and changes the shape of the eye so that the image falls on the retina, i.e. does not affect the causes of the disease, but fights only its consequences. The reasons why the shape of the eye changed in the wrong direction are: remain and continue to act with no less force. It is already known that the corrective effect of laser surgery weakens over time, although accurate long-term statistics of this weakening have not yet been obtained. Those. actually A hard contact lens, laser-cut from our living eye tissue, gradually becomes weaker. And the person returns to glasses again. Moreover, this is the best case scenario for him. More sad developments are also possible. It is known that over the years a person acquires additional diseases, the hormonal levels in his body change - all this can cause clouding and other serious problems with the cornea of the eye weakened by surgery. Or God forbid you get into some kind of trouble and get hit in the eye - the weakened shell can rupture and the consequences will be the most disastrous. The same can happen if you hit the ball poorly in some exciting game like volleyball, or if you lifted a bag of potatoes that was too heavy, or even just steamed in the sauna. Problems are guaranteed for you. In one of the Saturday issues of Komsomolskaya Pravda, an anecdote was published: “Laser vision correction. Inexpensive. The package includes a wand and a guide dog.” Truly, there is only a grain of joke in every joke.

And finally, the last thing. There are entire groups of the population for whom laser vision correction in any form is generally contraindicated. First of all, these are children under the age of at least 18 years, and according to some literary data, up to 25 years. The child grows, and the shape of his eye naturally also changes, which makes any artificial correction of this shape unreasonable until natural growth stops. Secondly, after 35-40 years, most people develop farsightedness. This is not a disease - it is a variant of the age norm. In this situation, laser vision correction done in youth ceases to fulfill its positive purpose and the person returns to glasses.

Complications of LASIK: analysis of 12,500 operations

Pashinova N.F., Pershin K.B.

Refractive lamellar corneal surgery began in the late 1940s with the work of Dr. Jose I. Barraquer, who was the first to recognize that the optical power of the eye could be altered by removing or adding corneal tissue. The term “keratomileusis” comes from two Greek words “keras” - cornea and “smileusis” - to cut. The surgical technique itself, instruments and devices for these operations have undergone significant evolution since those years - from the manual technique of excision of part of the cornea to the use of freezing the corneal disc with its subsequent treatment for myopic keratomileusis (MCM). Then the transition to techniques that do not require tissue freezing, and, therefore, reduce the risk of opacities and the formation of irregular astigmatism, providing a faster and more comfortable recovery period for the patient. A huge contribution to the development of lamellar keratoplasty, understanding of its histological, physiological, optical and other mechanisms was made by the work of Professor V.V. Belyaev. and his schools. Dr. Luis Ruiz proposed in situ keratomileusis, first using a manual keratome and, in the 1980s, an automated microkeratome—automated lamellar keratomileusis (ALK).

The first clinical results of ALK showed the advantages of this operation: simplicity, rapid restoration of vision, stability of results and effectiveness in the correction of high degrees of myopia. Disadvantages are the relatively high percentage of irregular astigmatism (2%) and the predictability of results within 2 diopters. Trokel et al in 1983 also proposed photorefractive keratectomy (25). However, it soon became clear that with high degrees of myopia, the risk of central opacities, regression of the refractive effect of the operation significantly increases, and the predictability of results decreases. Pallikaris I. et al., combining these two techniques into one and using (according to the authors themselves) the idea of cutting out a corneal pocket on a pedicle (Pureskin N., 1966), proposed an operation that they called LASIK - Laser in situ keratomileusis. In 1992 Buratto L. and in 1994 Medvedev I.B. published their versions of the surgical technique.

Since 1997, LASIK has gained more and more attention from both refractive surgeons and patients. The number of operations performed each year already amounts to millions. However, with the increase in the number of operations and surgeons performing these operations, with the expansion of indications, the number of works devoted to complications is also growing.

Materials and methods

In this article, we wanted to analyze the structure and frequency of complications of LASIK surgery based on 12,500 operations performed in Excimer clinics in the cities of Moscow, St. Petersburg, Novosibirsk and Kiev for the period from July 1998 to March 2000. Regarding myopia and 9600 operations (76.8%) were performed for myopic astigmatism; regarding hypermetropia, hypermetropic astigmatism and mixed astigmatism - 800 (6.4%); corrections of ammetropia in previously operated eyes (after radial keratotomy, PRK, end-to-end corneal transplantation, thermokeratocoagulation, keratomileusis, pseudophakia and some others) - 2100 (16.8%).

All operations under consideration were performed on a NIDEK EC 5000 excimer laser, optical zone - 5.5–6.5 mm, transition zone - 7.0–7.5 mm, and multizone ablation at high degrees.

Three types of microkeratomes were used:

1) Moria LSK-Evolution 2 - keratome head 130/150 microns, vacuum rings from –1 to +2, manual horizontal cut (72% of all operations), mechanical rotational cut (23.6%).

2) Hansatom Baush&Lomb - 500 operations (4%).

3) Nidek MK 2000 - 50 operations (0.4%).

As a rule, all LASIK operations (more than 90%) were performed simultaneously bilaterally. Topical anesthesia, postoperative treatment - local antibiotic, steroid for 4–7 days, artificial tear according to indications.

Refractive results correspond to world literature data and depend on the initial degree of myopia and astigmatism. George O. Warning III proposes that the results of refractive surgery be assessed according to four parameters: effectiveness, predictability, stability and safety. Under efficiency refers to the ratio of postoperative uncorrected visual acuity to preoperative best-corrected visual acuity. For example, if postoperative visual acuity without correction is 0.9, and before surgery with maximum correction the patient saw 1.2, then the effectiveness is 0.9/1.2 = 0.75. And vice versa, if before the operation the maximum vision was 0.6, and after the operation the patient sees 0.7, then the effectiveness is 0.7/0.6 = 1.17. Predictability- this is the ratio of the planned refraction to the received one. Safety- the ratio of maximum visual acuity after surgery to this indicator before surgery, i.e. A safe operation is when before and after surgery the maximum visual acuity is 1.0 (1/1=1). If this coefficient decreases, then the risk of the operation increases. Stability determines the change in the refractive result over time.

In our study, the largest group was patients with myopia and myopic astigmatism. Myopia from –0.75 to –18.0 D, average: –7.71 D. Observation period from 3 months. up to 24 months Maximum visual acuity before surgery was more than 0.5 in 97.3%. Astigmatism from –0.5 to –6.0 D, average –2.2 D. Average postoperative refraction –0.87 D (from –3.5 to +2.0), patients after 40 years were planned to have residual myopia. Predictability (±1 D, from the planned refraction) - 92.7%. Average astigmatism 0.5 D (from 0 to 3.5 D). Uncorrected visual acuity was 0.5 or higher in 89.6% of patients, 1.0 or higher in 78.9% of patients. Loss of 1 or more lines of maximum visual acuity - 9.79%. The results are presented in Table 1.

Complications include surgical, postoperative and late postoperative complications.

Surgical complications

As a rule, operational complications are associated with the technical support of the operation: loss of vacuum or its insufficiency during cutting, blade defects, incorrectly selected parameters of vacuum rings and stoppers.

Vacuum loss or insufficiency during cutting can be for several reasons:

insufficient exposure, i.e. the cut itself started very quickly and the vacuum did not have time to reach the required parameters
chemosis of the conjunctiva, filtration cushions after antiglaucomatous operations, scars and cysts of the conjunctiva and some other reasons can lead to the fact that the altered conjunctiva obstructs the vacuum hole of the ring and the device shows the presence of sufficient pressure for the operation, but it does not correspond to the true pressure of the eye at this moment
compression and displacement of the eye tissues during the passage of the keratome head can depressurize the eye system - the vacuum ring.

Blade defects - there may be a manufacturing defect, as well as damage to the blade during assembly of the microkeratome.

Very steep or flat cornea, as well as in some microkeratome models, incorrectly selected sizes of rings and stops can lead to a significant discrepancy between the expected and obtained sizes of the flap and the corneal bed.

The above reasons can lead to complications associated with the flap:

thin flap - 0.1%
uneven flap (step) - 0.1%
button-hole (flap with a round defect in the center) - 0.04%
full cut (free cap) - 0.3%
incomplete cut - 0.56%
split cut - 0.02%.

Epithelial defects - 1.43%. Total surgical complications - 1.27% of the total number of operations, because usually they were combined (thin section, uneven, split with an epithelial defect). Complications that worsen functions and affect long-term results - 0.15%, which can be expressed in a decrease in maximum visual acuity, monocular double vision, induced astigmatism or irregular astigmatism, corneal opacification.

To exclude as much as possible the possibility of surgical complications, the following rules must be observed: careful and attentive selection of patients according to the parameters of the preoperative examination; correct choice of rings and stopper; use of disposable blades only 1 time; control of the blade edge after assembling the microkeratome; control the vacuum before starting the cut; moisten the surface of the cornea during cutting, especially in older patients.

If a complication does occur, it is necessary to develop a clear algorithm of actions in each specific case and strictly adhere to it, regardless of the circumstances (a nonresident patient, financial or any other problems). In our opinion, this algorithm may be as follows: it is necessary to recognize the complication in time, under no circumstances do ablation (except for “free cap”), carefully straighten the flap or what is left, prevent epithelial ingrowth as much as possible, treat the patient until maximum acuity returns vision, repeat cutting should be carried out no earlier than 3 months. taking into account the reasons that led to the first complication, and, if possible, with a different diameter and a different depth.

In the case of a complete cut of the flap, ablation is performed, the flap is placed according to the marks, about 5 minutes. dried, its stability is checked. As a rule, no additional fixation is required, and this does not affect the final result. It should be noted that the proportion of surgical complications decreases 10 times after the first 200-300 operations.

Postoperative complications

In modern refractive surgery, this group of complications includes a large number of conditions: from inflammatory reactions to subjective patient dissatisfaction with the result of the operation. They can be schematically divided into complications associated

with flap: displacement, swelling, inflammation;
with interface: epithelial ingrowth, debris and inclusions, central islands, Sands of the Sahara syndrome (SOS) and/or Diffuse intralamellar keratitis (DLK), inflammation;
with ablation: Hypo/hypercorrection, decentration, irregular astigmatism;
with other eye diseases: retinal detachment, macular edema, macular hemorrhage, Bowman's membrane diseases, autoimmune diseases, toxic keratopathies (glandular secretions, oil or other material from the keratome, debris, etc.), progression of cataracts, progression of macular degeneration, keratoectasia (induced keratoconus). And as a separate group, we can distinguish the subjective discrepancy between the results of the operation and the patient’s expectations.

Complications associated with the flap

Displacement of the superficial flap occurred in 0.04% of cases, which required its reposition, usually seamless, but sometimes it is necessary to use a contact lens or sutures. Flap swelling occurred in 0.03% of cases and required conservative treatment. Inflammations were more common (0.23%) in the form of herpetic keratoconjunctivitis (8 cases), bacterial keratoconjunctivitis (6 cases) and fungal keratoconjunctivitis (2 cases).

Interface-related complications

Epithelial ingrowth, affecting visual functions and requiring surgical intervention, was rare - 0.07% of cases.

Debris and inclusions (“garbage” under the flap) biomicroscopically can be detected almost always, but there has not been a single case in which this affected the functional result.

Central islets in topographic studies they are relatively rare (0.04%). The etiology of this phenomenon is not completely clear. One explanation may be that the vacuum ring, increasing IOP more than 65 mm Hg. Art., changes the “pressure of corneal edema,” which leads to its dehydration. After the vacuum is removed, hydration occurs. The central cornea swells more rapidly and more than the periphery, which can lead to interface folds and flap formation.

The interface, like a pump, draws in water and debris during and after surgery until the epithelial barrier is restored. In these cases there is decrease in both maximum possible and uncorrected vision. As a rule, they gradually disappear within a period of 1 to 3 months. after operation.

SOS or nonspecific diffuse intralamellar keratitis (DLK), first described by Smith & Maloney in 1998, according to several authors, occurs with a frequency of 1 in 500 to 1 in 5000 operations. Develops 2–5 days after surgery. There are four stages of DLK (Eric J. Linebarger 1999): stage 1 - whitish inclusions in the interface along the periphery, which do not reduce vision; Stage 2 - point inclusions throughout the interface, including the center, which do not reduce vision or reduce it by 1–2 lines; Stage 3 - point inclusions in the center begin to merge into conglomerates and a significant decrease in vision occurs; Stage 4 - melting of the flap. We encountered this complication 8 times (stage 2–3), which amounted to 0.07% of all cases. This small percentage is explained by the fact that only cases requiring additional conservative or surgical intervention were taken into account. The causes of DLK are not completely clear. Some authors explain this by trophic changes, others by a toxic-allergic reaction of the cornea to the secretions of Bowman's glands or to microscopic particles of metal and microkeratome oil. In our opinion, the most successful concept was proposed by V.V. Kurenkov. with co-authors and called “Syndrome of disadaptation of the superficial corneal flap”. They consider the formation of striae and folds of the superficial flap after LASIK as the initial stage in the development of DLK. The authors see the reason for this in the incongruence of the ablated surface of the corneal stroma and the surface flap placed on it.

We, like most authors, adhere to active tactics in the treatment of DLK. It is more reasonable to carry out an examination after surgery on the second day. If the development of DLK is suspected, steroids should be administered locally in drops and subconjunctival injections for 1-2 days. In the absence of positive dynamics or an increase in clinical manifestations, it is necessary to lift the superficial flap and thoroughly rinse both the stromal bed and the inner surface of the superficial flap with dexamethasone solution. In foreign literature there are references to the successful use of cytostatics (methotrexate) in such cases.

Inflammation was not common, in 0.1% of cases (10 eyes). Of these, 5 were cases of herpetic stromal keratitis, 2 were chlamydial and 3 were bacterial with an unknown pathogen.

Complications associated with ablation

The third, largest group of complications is associated directly with ablation. Hypocorrection and regression (smaller refractive effect of the operation or its reduction from the planned one by more than 0.5 D) noted in 16% of cases. Of these, 12.4% required reoperations. Hypercorrection (greater effect of surgery by 0.75 D and above) were encountered much less frequently - 0.2%, of which reoperations - 0.07%. Decentrations affecting functions in the form of monocular diplopia, glare, halos, decreased vision in the dark or in bright light - 0,1%.

All of these patients underwent reoperations using masking agents or displaced ablation. The CAP method using the VISX excimer laser greatly facilitates such interventions.

Induced astigmatism (more than 0.5 D) and irregular astigmatism was in 0.35% of cases, of which 0.18% required reoperations. Irregular astigmatism developed with decentrations, flap and interface problems. Analyzing this type of complications, we noticed that their number is much higher in patients with existing corneal scars (traumatic scars, conditions after penetrating corneal transplants and radial keratotomy, pseudophakia after EEC, etc.). Apparently, the intersection of a through corneal scar with a microkeratome leads to changes in biomechanical properties and parameters, which unpredictably affects the shape of the cornea and its refraction.

In a group of patients who underwent LASIK after penetrating corneal transplantation for keratoconus, significant induced astigmatism was detected in more than 50% of cases. After we switched to the two-stage LASIK technique, the incidence of this complication in these patients does not exceed that in patients with normal myopia. The essence of the technique is that the first step is to cut the surface flap with a microkeratome without ablation, after which the flap is placed in place. Based on the topographic picture, they wait until the corneal refraction stabilizes (usually 2–4 weeks), after which the flap is raised and ablated according to the new topographic data.

Total the total number of reoperations (lifting the flap or a new cut for additional correction or for washing the interface) was 12,8% .

Some data on operative and postoperative complications in comparison with the analysis of complications after LASIK conducted by the European and American Societies of Refractive and Cataract Surgeons are presented in Table. 2. A large percentage of surgical complications in 1998 is associated with mastering both the methodology as a whole, so training of each individual surgeon. According to leading refractive surgeons, the percentage of surgical complications decreases by an order of magnitude after the first 200-300 operations.

Complications associated with other eye diseases

Fortunately, the vast majority of complications associated with other eye diseases cannot be directly associated with the correction itself. More often they are associated with a severe initial condition of the myopic eye.

Retinal disinsertion- in 5 eyes, which amounted to 0.05% of the group of patients with myopia and 0.04% of all operations. In all cases, detachment occurred no earlier than 4–6 months after surgery. All patients had previously undergone prophylactic peripheral laser coagulation (PPLC) of the retina.

Patient L., 19 years old, LASIK for high myopia (–8.0 D). PPLC in 14 days. Vis OU = 1.0 after correction. After 8 months retinal detachment of the left eye. Sectoral filling. One month after surgery Vis OD = 1.0; Vis OS = 0.6 s/k 0.8.
Patient K., 43 years old. Myopia 9.5 D. PPLK OU 7 years ago. LASIK OU with planned residual myopia –1.5 D. On day 10 Vis OU = 0.7-0.8 sph - 1.0 = 1.0. After 2 months Vis OD = 0.6 sph - 1.25 = 1.0; Vis OS = 0.3 sph - 2.25 = 1.0. At the request of the patient, additional correction was performed (without a new cut). Vis OU = 0.9 - 1.0. After 4 months after the first operation, retinal detachment OS. A cerclage with radial filling was performed. Vis OS = 0.6 n/k. After 6 months Vis OD = 0.9 sph - 0.75 = 1.0; Vis OS = 0.2 - 0.3 n/k.
Patient D., 47 years old. Myopia - 7.0 D. PPLC OU 10 years ago. After LASIK Vis OU = 0.6 sph - 1.0 = 0.8 (maximum possible). Retinal detachment OD after 8 months. after correction. The operation for detachment, at the request of the patient, was carried out in another clinic.
Patient P., 46 years old. Myopia OU - 10.0 D. PPLC 14 days before correction. OD injury 1.5 years after LASIK. Operated at the place of residence.
Patient N., 34 years old. LASIK for high myopia (OD - 7.0 D, OS - 9.0 D). PPLC 1 month before surgery. Vis OU = 0.6 s/k 0.9. 6 months after surgery, retinal detachment OS. Sectoral filling. Vis OS = 0.3 c/k 0.5.

Macular edema was present in one eye (0.01%) in a patient with very high axial complicated myopia. Patient L., 28 years old. Very high myopia (SE = - 22.0 D). Vis OU with corr. = 0.4. LASIK on one eye with multi-zone ablation (6 zones). The next day SE = + 0.75 D. Vis = 0.05 n/k. There is macular edema in the fundus. 2 weeks later, after a course of conservative therapy, Vis = 0.3.

Macular hemorrhage also occurred 1 time (0.01%). The patient is 74 years old with pseudophakia (EEK+IOL more than 4 years ago), myopia and myopic astigmatism. LASIK was performed with good refractive and visual effect. 14 days after surgery, vision decreased sharply due to macular hemorrhage.

Progression of cataracts We noted in 5 patients (0.04%), of which in two cases phacoemulsification with IOL implantation was performed. It should be noted that in all these cases, cataracts were identified during the preoperative examination and patients were warned in advance about the possibility of its progression.

Keratoectasia after LASIK (induced keratoconus), according to the literature, is quite rare if the surgical parameters are not observed (residual postoperative corneal depth of at least 250 microns and total corneal thickness after surgery of at least 400 microns) or if keratoconus is not detected during preoperative examination. Only in the article Amoils S.P. et al., 2000 reported 13 cases of iatrogenic keratoconus in patients with myopia from - 3.0 to - 7.0 diopters, with normal corneal thickness, no evidence of initial keratoconus before surgery and normal parameters of the operation. In this case, keratoconus developed 1 week - 27 months after LASIK.

We have identified induced keratoconus in two patients in 3 eyes (0.02%), one of which underwent penetrating keratoplasty. In two cases (one patient) it was not detected initial keratoconus. In the third case (myopia with SE = - 12.0 D), 250 microns of intact cornea are left, the microkeratome head is 130 microns thick.

Toxic epitheliopathy in the long-term postoperative period(0.04%), as a rule, require conservative treatment and do not ultimately affect the outcome of the operation.

In one patient (0.01%) 2 years after LASIK, dry form of macular degeneration, which currently does not reduce visual acuity.

We did not identify complications associated with diseases of Bowman's membrane, autoimmune and systemic diseases.

Total If we sum up all the complications encountered, deviations from the normal course and side effects of LASIK, we get 18,61% . Quite often they are combined in one patient. For example, an uneven cut of a microkeratome with an epithelial defect during surgery can lead to epithelial ingrowth in the postoperative period, which, in turn, can lead to the occurrence of induced or irregular astigmatism, and, consequently, a decrease in visual acuity. Complications affecting the visual result in the long-term postoperative period, after reoperations (total reoperations - 12.8%), were 0.67%.

A separate group consists of patients in whom, according to the surgeon, everything is excellent, which is confirmed by clinical data, but they subjectively dissatisfied with the result. This discrepancy between the result of the operation performed by the ophthalmic surgeon and the patient’s expectations leads to the most intractable problems between them. The prevalence and relative accessibility of refractive surgery against the backdrop of weak insurance medicine and significant gaps in the legislative framework that currently determines the relationship between clinic - doctor - patient makes this problem very urgent.

Conclusion

The rate of complications depends more on the experience of the surgeon and the clinic as a whole than on the type of microkeratome and laser. However, it should be noted that each microkeratome and excimer laser have their own specific features.
The presence of different keratomes and lasers expands the surgeon's capabilities in atypical cases.
The presence of various vacuum rings and microkeratome heads of different cutting depths allows you to optimize the parameters of each specific operation.
The “Low Vac” mode of the microkeratome ensures reliable centering of ablation, speeds up the procedure and reduces the risk of complications.
Stepwise vacuum removal reduces corneal hydration, which increases the stability of the laser and reduces the effect of absorption of liquid and debris under the flap.
Standardization of surgical technique, methods of dealing with complications and postoperative management can significantly improve results. It should be noted that Not only the work of the surgeon, but also the entire clinic team, including diagnostics, operating nurses and engineering staff, is subject to optimization. Only in this case can you achieve consistently good results, and failures in any of the links will not entail serious clinical consequences.
A thorough and detailed discussion with the patient of indications and contraindications for a specific refractive surgery; the patient’s understanding of how and what they are going to do with him; awareness that the patient himself also accepts risks associated with complications independent of the surgeon and equipment; identification by the doctor of the patient’s unreasonable expectations from the result of the operation - all this will eliminate conflicts between the patient and the doctor, and, consequently, improve the quality of refractive surgery in general.

Literature

Barraquer J.I. Queratoplastia Refractiva. Estudios Inform. 1949; 10:2-21.
Barraquer J.I. Results of myopic keratomileuses. J. Refract. Surg.1987; 3:98-101.
Barraquer J.I. Keratomileuses. Int. Surg. 1967; 48:103-117.
Swinger CA, Barker BA. Prospective evaluation of myopic keratomileuses. Ophthalmology. 1984; 91:785-792.
Nordan LT. Keratomileuses. Int. Ophthalmol. Clin. 1991; 31:7-12.
Belyaev V.S. Operations on the cornea and sclera. Moscow,: Medicine, 1984, 144 p.
Slade SG, Updegraff SA. Complications of automated lamellar keratectomy. Arch. Ophthalmol. 1995; 113(9): 1092-1093.
Trokel S, Srinivasan R, Braren B. Excimer laser surgery of the cornea. Am. J. Ophthalmol. 1983; 94-125.
Pureskin N.P. Weakening of eye refraction by partial corneal stromectomy in an experiment. Vestn. Ophthalmol. 1967; 8:1-7.
Pallikaris I, Papatzanaki M, Stathi EZ, Frenschock O, Georgiadis A. Laser in situ keratomileuses. Laser Surg. Med. 1990; 10:463-468.
Buratto L, Ferrari M, Rama P. Excimer laser intrastromal keratomileuses. Am. J. Ophthalmol. 1992; 113:291-295.
Medvedev I.B. Improved technology of myopic keratomileusis for high myopia. Diss. Cand. Honey. Sciences - Moscow, 1994, 147 p.
George O. Waring III. Standard graphs for reporting refractive surgery. J. Refractive Surg. 2000; 16:459-466.
Kurenkov V.V., Sheludchenko V.M., Kurenkova N.V. Classification, causes and clinical manifestations of complications of laser specialized keratomileusis for the correction of myopia and hypermetropia. Vestn. Ophthalm. 1999; 5:33-35.
Amoils SP, Deist MB, Gous P, Amoils PM. Iatrogenic keratectasia after laser in situ keratomileuses for less than -4.0 to -7.0 diopters of myopia. J of Cataract & Refractive Surg. 2000; 26:967-978.

Here is a small excerpt from Svetlana Troitskaya’s book “Get Rid of Killer Glasses Forever!” .

And here is what Igor Afonin writes about laser correction in his book “Take off your glasses in 10 lessons. Book-vision".

Lately there has been more and more talk about laser surgeries. Sometimes they are presented as the only solution for people with poor vision. However, even after laser surgery you cannot count on 100% vision. In addition, for laser surgery, as in general for any serious surgical intervention, there are contraindications. For example, surgery cannot be performed on those under 18 years of age. You should not go under the laser if you have progressive myopia, eye diseases, pregnancy, or infectious diseases. After the operation, you must follow certain doctor's instructions and be under his supervision for at least 3 months.

And the cost of the operation is considerable, since it consists of many components. This includes computer diagnostics, consultations, and the operation itself. It comes out to about 2-3 thousand dollars. So think carefully, dear reader, before you take this step.

And if you’ve almost made up your mind, think about this. Doesn't it bother you that most ophthalmologists still wear glasses?

Food for thought.

Below you can see photographs of the richest people on our planet in 2007, all of them are billionaires. They understand perfectly well what risk is. They have the opportunity to pay for the most highly qualified doctors. Question: why are they still wearing glasses?

Restoration of vision after laser correction of ophthalmic refractive errors (farsightedness, myopia, etc.) depends on several factors. Firstly, the patient’s well-being and the condition of the eye depend on how much the doctor took into account all the characteristics of the human body and whether there were any contraindications for the operation. Secondly, rehabilitation is easier and faster if the surgical intervention itself was performed by an experienced, qualified specialist and in a well-equipped medical center. Thirdly, the person himself is responsible for the successful restoration of the ability to see, and he must follow all the doctor’s recommendations in the postoperative period. To dispel doubts and fears about the operation and further rehabilitation, you need to understand all the factors separately.

How contraindications can affect eye recovery

During eye rehabilitation after LASIK correction, some negative effects may occur. They may be associated with diseases for which this procedure is contraindicated. That is, the doctor must take the following measures before making a decision on surgery:

Check the patient for ophthalmological diseases: cataracts, glaucoma, retinal dystrophy and detachment (if the patient has undergone surgery to correct it), fundus pathology, progressive myopia. In addition, inflammatory and infectious processes in the eyeball also prevent the use of this technique.
The doctor takes into account autoimmune diseases, AIDS, diabetes mellitus in the form of decompensation, and herpes infection in the body.
For patients, it is mandatory to check whether the woman is pregnant, since such a procedure is not performed when carrying a child.

Eye pathologies complicate the healing of tissues affected by this manipulation and general systemic disorders in the body. If there is an infection in the human body, it can spread to healthy tissue during manipulation, which will also complicate rehabilitation. And during pregnancy and breastfeeding, many medications that are simply necessary for the healing of the cornea are contraindicated.

If a person’s examination does not reveal such contraindications before using LASIK, then the processes of restoration of the eye and visual ability should proceed normally.

How does the progress of surgery affect rehabilitation?

There are now many centers for visual restoration that actively advertise their services. But it should be taken into account that complications are also possible as a result of surgeon errors. Therefore, you can entrust your eyes only to experienced specialists in large centers who have long proven themselves and have good reviews from the patients themselves. When manipulations are performed correctly by qualified surgeons, the recovery period passes in most cases without complications.

To ensure that the manipulation itself is successful and that no problems arise immediately after the procedure, you need to remember the following preparation nuances:

all preliminary tests prescribed by the doctor must be performed;
You cannot wear contact lenses for about two weeks before the procedure;
to eliminate negative consequences from the administration of drugs, it is necessary to give up alcoholic beverages at least two days in advance;
before going to the ophthalmology center, you need to take sunglasses with you (they will come in handy after the procedure), wear clothes with a loose collar (to prevent damage to the operated eyes);
It is advisable to wash your hair in advance - you cannot do this for three days after the manipulations. Women should not use eye cosmetics at least 24 hours before the procedure.

You should learn about the preparation rules directly from your doctor: each ophthalmology center may have its own characteristics.

Rules to follow during rehabilitation

The rehabilitation period depends on how conscientiously the patient adheres to the rules. If a person is prepared for the restrictions that will be necessary to improve refraction, the risk of complications (including vision deterioration after laser correction) will be minimal. So, what are the contraindications after laser vision correction?

People who have been involved in sports, especially contact sports, should be prepared to completely abandon such hobbies. After using LASIK, increased stress on the body is eliminated, especially in the first weeks. Whether the doctor will allow you to train and take part in competitions in the future will depend on the success of the intervention and the condition of the eyeball. Lighter sports are usually not prohibited, and a couple of weeks after the manipulations a person will be able to return to training (though at first only with half the load).

If a person experiences increased stress at work, he may have to change jobs (or at least take a long vacation - this is decided by the attending physician).

Even physical activity that a person experiences at home (for example, lifting weights) can affect the healing process. In the first time after the intervention, even short-term overexertion can be dangerous; in the future, adverse consequences can arise if the permissible load is regularly exceeded.

In addition, after laser vision correction you cannot:

wash and shower on the first day after the procedure. After this, you can wash your face only with boiled water;
rub your eyes, expose them to the risk of mechanical damage or dust. While the visual analyzer is being restored, it is not recommended to travel outside the city, where there is a high probability of dust particles getting into the eyes with gusts of wind;
expose your eyes to bright sunlight: it is better to wear sunglasses, and it is not recommended to sunbathe for a month;

be exposed to high temperatures, visit a bathhouse or sauna for 4 weeks;
women, while the cornea is recovering, use eye cosmetics and aerosols that can get on the cornea (hairspray);
on the first day, work at the computer and sit in front of the TV screen.
drive vehicles (the doctor must indicate for how long) due to the likelihood of glare in the eyes;
be exposed to hypothermia and direct exposure to cold wind on the eyes: inflammatory processes and infectious diseases will increase the healing time of the cornea;
swim in open water until the end of rehabilitation therapy: there is a high probability of pathogenic microorganisms getting on the damaged membrane of the eyeball.

A complete list of everything that cannot be done after laser vision correction should be obtained from your doctor. Often, ophthalmology centers issue special instructions that help the patient navigate the rules of conduct after the procedure.

To help the cornea recover faster, you need to use special drops. In the first days you will need a whole list of medications, including hormonal and antibacterial ones; Over time, the amount of medication needed decreases. However, there is a possibility that drops to moisturize the cornea will have to be used periodically in the future.

Is it possible to have a child after using LASIK?

Women who are planning to correct ophthalmological pathology (for example, astigmatism) are interested in: is it possible to give birth after surgery? Pregnancy itself is a contraindication for surgery, as is breastfeeding. If a woman is pregnant and about to give birth, she needs to wait until she finishes breastfeeding.

Pregnancy after laser vision correction is not contraindicated. However, in the first 3 months (and sometimes a little more - you should ask your doctor about this) it is necessary to use protection. The fact is that when healing wounds on the cornea, it is necessary to use antibacterial and hormonal agents, and they can negatively affect the development of the fetus. It is possible to give birth after laser vision correction after the specified period.

And childbirth is a completely compatible concept. But it is worth remembering that in order to avoid negative consequences, you need to not only postpone pregnancy after correcting the cornea, but also in some cases opt for a cesarean section.

Natural childbirth after laser vision correction can be dangerous, because during contractions the woman in labor experiences very strong tension, which can cause vision loss.

How quickly does the ability to see return?

Typically, indications for such intervention are myopia, farsightedness, and astigmatism. Moreover, the doctor can recommend correction only with LASIK if the decrease in visual ability is 25–40%. That is, before the intervention the person sees very poorly. If you do not take into account some postoperative symptoms (which will be discussed below), a significant improvement in the quality of refraction occurs within 24 hours. How long this result will last is unknown, but usually refractive problems are solved for many years. Repeated exacerbation and deterioration in the quality of refraction develops, as a rule, due to age-related changes in the eyeball.

Possible consequences

The consequences after laser vision correction can be different. Normal symptoms include extraneous glare and stars in front of the eyes, as well as a feeling of dryness in the eyeball. To eliminate this discomfort, special moisturizing drops are used. After laser vision correction, fog in the eye also appears in many patients, but this sensation soon passes. You also need to be prepared for the fact that the ability to see in the twilight (provided by the peripheral part of the retina) may deteriorate for a very long period.

Sometimes the eye tissue becomes inflamed and conjunctivitis occurs. Hemorrhage and epithelial ingrowth due to improper healing are also possible.

But with the right selection of an ophthalmological center and surgeon, as well as following the rules during rehabilitation, the likelihood of serious complications is minimized.

Deterioration in visual ability after the procedure

Almost all patients are very concerned about the question: is it possible to go blind after laser vision correction? Practice shows that complete blindness does not occur after such an intervention. A slight drop in the quality of refraction sometimes occurs when the corneal flap is cut incorrectly, which is removed with a special blade so that the necessary layer of the eyeball becomes accessible for manipulation.

Refraction may deteriorate due to an error in calculating the depth of penetration into the cornea, while myopia may be replaced by farsightedness, and astigmatism may remain, but with different indicators.

Such negative consequences occur very rarely. Repeat surgery may be necessary to correct them.

Sometimes visual ability decreases due to non-compliance with the rules of behavior during the healing period. So, if you start rubbing it as hard as you can, unable to endure the discomfort in the eye in the first day, the corneal flap will shift, which will entail a disruption of the light-conducting system of the eyeball.

If your vision has decreased after laser correction, you should definitely inform your doctor about it. He will determine whether this may be a complication caused by the operation itself, or whether the patient himself does not adhere to the recommendations during rehabilitation. The ophthalmologist will decide whether any additional medications or procedures are needed, or whether a repeat operation is needed.

The limitations after laser vision correction are quite impressive, but the ability to see the world around us, which returns after the intervention, compensates for all the difficulties. If you behave correctly when preparing for surgery (pass all the necessary tests and choose a good ophthalmology center), and also follow all the rules during rehabilitation, the chance of overcoming farsightedness, myopia or astigmatism in this way is very high.