Lasik Eye Surgery Gone Wrong - Risks & Complications

Laser-assisted in-situ keratomileusis (LASIK), stands for ‘in-situ’ meaning ‘in position’, and ‘keratomileusis’ meaning ‘reshaping the cornea’. LASIK is a common eye surgery in which the doctor uses a laser to correct vision, especially refractive errors. A refractive error occurs when the eye fails to bend light correctly to create a picture exactly on the retina, distorting vision.

LASIK helps to correct refractive errors like astigmatism (a condition causing blurred vision), far-sightedness (hyperopia), and near-sightedness (myopia). However, did it ever happen that a LASIK eye surgery gone wrong?

The main question that might be bothering you is that has LASIK eye surgery gone wrong? Like every other surgery, even LASIK surgery has risks and complications. However, a person who wants to undergo LASIK surgery must be aware of its risks, complications, and be clear about expectations.

LASIK surgery risks and complications can arise during the LASIK surgery (intraoperative) and after the LASIK surgery (postoperative).

Intraoperative complications

1. Intraoperative complications may arise during LASIK surgery. During the surgery, a few complications may occur while using a femtosecond laser and microkeratome (surgical instrument).

Femtosecond laser (FSL)-related flap complications

1. Rainbow glare: The patient sees a ‘rainbow glare’ when looking at the white light.
2. Vertical gas breakthrough: The mechanism by which FSL works may create bubbles within the flap (folds in the cornea). Usually, these bubbles resolve with flap lifting, but the gas bubble can sometimes escape, which may cause complications.
3. Anterior chamber gas bubbles: The gas bubbles may enter the anterior chamber of the eye.
4. Microkeratome-related flap complications
   1. Flap buttonhole: A failure to get a lamellar cut may result in a hole in the flap that looks like a ‘doughnut’. The risk factors include the steep cornea, suction loss, corneal scar, prior corneal surgery, defective blade, etc.
   2. Free cap: This complication occurs when the whole flap gets dislodged from the cornea. The risk factors include a flat cornea, inadequate suction, defective blade, etc
   3. Corneal perforation: Perforation (hole) in the cornea is rare but a severe complication. The risk factor includes very thin corneas, improper assembling of older models of mechanical microkeratomes, etc.
   4. Short, incomplete, or irregular flaps: Complications can occur if the microkeratome stops prematurely. The risk factors include suction loss, flat cornea, corneal scars, etc.

Microkeratome and FS-related flap complications

1. Epithelial (outermost corneal layer) defect: This complication can occur due to a steep cornea, older age, previous cornea trauma, diabetes mellitus, history of contact lens use, etc. An epithelial defect can lead to delayed healing, infectious keratitis, epithelial ingrowth, and flap striae.
2. Interface debris: While lifting and creating the flap, debris may accumulate within the interface, e.g., talc from gloves, red blood cells, etc.
3. Limbal (narrow band of tissue that encircles the cornea) bleeding: Risk factors include hyperopia, large diameter flaps, etc.

Postoperative complications

1. Under-correction and overcorrection: Improper assessment of refraction, data entry error in the LASIK machine, lack of machine calibration, etc., can cause complications like under-correction or overcorrection.
2. Flap dislocation: Flap dislocation may occur due to excessive squeezing of the eyelid, excessive dry eyes, eye rubbing, poor intraoperative repositioning, and trauma.
3. Flap fold or striae: The risk factor includes poor repositioning of the flap at the end of the surgery, thin flaps, etc.
4. Dry eye: The causes include pre-existing dry eye disease, cell damage during suction, postoperative inflammation, etc.
5. Infectious keratitis: This complication is quite a rare but vision-threatening complication. The infection occurs under a LASIK flap. A person may experience redness, pain, photophobia, etc.
6. Epithelial ingrowth: This complication may occur due to the implantation of epithelial cells during the surgery or later migration of cells from the flap edge.The risk factors include poor adhesion of the flap edges, free cap, etc.
7. Rare complications: Some rare complications that may occur are retinal detachment, ischemic optic neuropathy (insufficient blood flow to the eye’s optic nerve), vitreous haemorrhage (blood in the eye's vitreous cavity), etc.

Other complications

1. De-centered Laser Ablations: This occurs when the laser treatment is not adequately centred on the pupil. An ablation even as small as 0.5mm of off-center can result in visual complications.
2. Ptosis: This happens when the top eyelid hangs over the pupil. The eyelid may sag somewhat or a lot, covering the pupil. Normal vision may be partially or fully obscured by ptosis.
3. Corneal Ectasia: This is a rare complication, characterised by increasing corneal bulging and thinning and is associated with decreasing eyesight.
4. Subconjunctival Hemorrhage: This occurs when the blood vessels might burst in the conjunctiva of the eye. Blood is spilled if and when they are damaged between the conjunctiva and sclera.
5. Kerectasia: This is a non-inflammatory condition that causes the corneal stroma to thin and may result in corneal bulging.
6. Diffuse Lamellar Keratitis (DLK): This can be defined as a  possible sterile early postoperative stromal/interface inflammation of the eye.

Now you must be aware that a LASIK surgery can go wrong, although rarely. However, these side effects might subside in roughly a month. The side effects might occur for a shorter duration in some people while it might take longer to resolve in others. Some of the common side effects of LASIK surgery are as follows:

1. Pain or discomfort in the eye
2. Foggy, hazy, or blurry vision
3. Dry eyes
4. Vision that changes throughout the day
5. Sensitivity to light
6. Halos, glare, or starburst effects around bright lights
7. Infection
8. Small red or pink bloody patches on the eye’s white part
9. Vision that is worse than it was before the surgery (rare)
10. Blindness (extremely rare)

However, rarely, these side effects may remain permanently.

The first few steps in deciding whether you are the right candidate are:

1. Age: You need to be at least 18 years old but ideally somewhere in your early 20s and mid 20s.
2. Eyes: Make sure you have healthy eyes i.e. your prescription is constant for at least a year.

Other tests performed by your doctor to check if you are the right candidate are:

1. Corneal topography
2. Corneal tomography 
3. Epithelial thickness mapping 
4. Corneal biomechanical metrics
5. Pupil size measurement
6. Vision check 
7. Dry eye disease test

There are a number of eye conditions that may prevent a person from getting LASIK. Some of these conditions may be, but are not limited to, as follows:

1. Glaucoma
2. Diabetes
3. Cataract
4. Various severe dry eye disorders
5. Autoimmune diseases 
6. Keratoconus
7. Very thin cornea that may not be able to withstand the procedure
8. People with extreme astigmatism
9. People with extreme near or farsightedness.
10. Unstable vision (constant change in the prescription).

While LASIK is considered a safe and effective procedure, there are some risk factors that can increase the chances of complications or worsen the severity of complications. These may include:

1. Age: LASIK is typically recommended for individuals over 18 years old. Younger patients may still have an unstable vision prescription, which can increase the risk of complications.
2. Prescription strength: Patients with high prescriptions, especially those with severe myopia or hyperopia, may have a higher risk of complications, such as corneal thinning or irregular healing.
3. Corneal thickness: The thickness of the cornea can affect the amount of corneal tissue that can be safely removed during LASIK. Patients with thin corneas may have a higher risk of complications.
4. Dry eye syndrome: Patients with pre-existing dry eye syndrome may experience worsened symptoms after LASIK. This can lead to discomfort, blurry vision, and an increased risk of infection.
5. Previous eye surgery: Patients who have undergone previous eye surgeries, such as cataract surgery or glaucoma surgery, may have a higher risk of complications during LASIK.
6. Pregnancy: Hormonal changes during pregnancy can affect vision, making it difficult to obtain accurate measurements of the eye prior to LASIK. It is recommended that women wait until after pregnancy to undergo LASIK.
7. Certain medical conditions: Patients with certain medical conditions, such as autoimmune diseases or diabetes, may have a higher risk of complications during LASIK.
8. Active eye infections or inflammation: Patients with active eye infections or inflammation may need to delay LASIK until the condition is resolved to prevent the risk of complications.
   1. Activities like swimming, using pools or hot tubs or Rubbing your eyes after surgery.
   2. Using eye make up, using eye lotions, creams or other products not prescribed by your doctor.

These complications are easily avoidable. Simple ways to avoid or correct these complications are:

1. Dry eyes: Use artificial tears to help lubricate the eyes and reduce dryness. Your doctor may also recommend prescription eye drops or other treatments, such as punctal plugs, to help improve tear production.
2. Flap complications: If the corneal flap created during LASIK becomes dislodged or damaged, additional surgery may be necessary to reposition or replace the flap.
3. Regression: If your vision begins to regress after LASIK, your doctor may recommend additional treatment, such as a LASIK enhancement, to improve your vision.
4. Halos and glare: These symptoms are usually temporary and can be treated with prescription eye drops or other medications. If the symptoms persist, your doctor may recommend additional surgery or a different type of corrective procedure.
5. Infection: Infections after LASIK are rare, but if they occur, they can be serious. If you experience redness, pain, or discharge after LASIK, contact your doctor immediately. Treatment may involve prescription antibiotics or other medications.
6. Corneal ectasia: This is a rare complication that can occur years after LASIK. If you experience thinning of the cornea or other signs of corneal ectasia, your doctor may recommend additional treatment, such as corneal cross-linking or a corneal transplant.
7. Do not go swimming and avoid pools, hot tubs until your doctor has allowed it.
8. Don't use any eye make-up or creams for at least 3 to 4 weeks after your surgery.
9. Avoid rubbing your eyes after the surgery.

A lot of people don’t qualify for LASIK surgery. There are many other alternatives that may benefit such patients. These alternatives are:

1. LASEK (Laser-Assisted Subepithelial Keratectomy)
2. PRK (Photorefractive Keratectomy)
3. SMILE (Small Incision Lenticule Extraction)
4. Phakic Intraocular Lenses (IOLs)
5. Refractive Lens Exchange Surgery

You must contact your ophthalmologist immediately if your side effects are getting worse or if you feel that your LASIK surgery went wrong. Watch out for the following red flags after your LASIK surgery:

1. Pain
2. Dry eyes
3. Photophobia
4. Infection (redness, pain)
5. Blurry vision
6. Halo formation around bright lights
7. Worsening of vision
8. Tiny pink and red bloody patches on the white region of the eye.

What is the success rate of LASIK surgery?

1. Most people believe that their LASIK surgery will go wrong. However, several studies have reported that around 95% of people who have had LASIK surgery are happy and satisfied with their results. The duration of recovery after LASIK surgery is quick.
2. There are chances that you may be able to return to the majority of your routine activities the next day. The occurrence rates of complication of LASIK surgery are below 1% and are further reducing with the ongoing development of new technology.

Overcome the fear that your LASIK surgery can go wrong! We require healthy vision for every activity including driving, reading and working to name a few. For people who have vision problems due to refractive errors, LASIK eye surgery is a great option. However, before undergoing LASIK surgery, it is best to have detailed information about the surgery, including its advantages and disadvantages. 95% of people are satisfied with their LASIK surgery.

Now, you are aware of the LASIK surgery risks, yet if you feel your LASIK surgery can go wrong, consult your ophthalmologist. If you have any further questions, feel free to contact our personal care team at HexaHealth. Our trained experts will solve all your problems. You can also visit our website HexaHealth to learn more about LASIK surgery and other eye surgeries.