Surgical and Postoperative Complications of LASIK, LASEK, PRK

The following charts taken from two scientific review articles contain all surgical and postoperative complications associated with LASIK. Surface procedures like PRK, LASEK, Epi-LASIK do not lead to microkeratome-associated intraoperative complications but they have a higher risk of haze, scarring and postoperative pain. The IntraLASIK or so-called "All Laser LASIK" with femtosecond laser flap creation also doesn't lead to microkeratome-associated intraoperative complications but, like standard LASIK, they have a risk of postoperative flap complications. IntraLASIK is associated with a higher risk of Diffuse Lamellar Keratitis (DLK) and Transient Lightsensitivity Syndrome (TLS).


Keratome and flap complications
Intraoperative complications (0.3 to 5.7%)
Ectasia
Flap striae (up to 10%)
Flap dislocation (up to 2%)
Laser complications
Misinformation / improper ablation
Decentered or improperly registered ablation
Reduced qualtity of vision
Complications of healing / infection / inflammation
Recurrent corneal erosions
Infectious keratitis (0.03%)
Epithelial ingrowth (1%)
Diffuse lamellar keratitis (DLK)
Post-LASIK dry eye (48% during the first six months)
Other complications of LASIK
Intraocular pressure management after LASIK
Optic neuropathy and glaucoma
Schallhorn SC, Amesbury EC, Tanzer DJ. Avoidance, Recognition, and Management of LASIK Complications. A, J Ophthalmol 2006;141:733-739.




1. Inadequate alignment with astigmatism axis
2. Irregular flap cuts
Partial Flaps
Thin Flaps
Donut-shaped flaps
Decentered flaps
Free caps
3. Complications due to improper microkeratome assembly or defective blades
4. Intraoperative bleeding
5. Intersecting microkeratome cuts
6. Excimer laser ablation-related complications
Input errors
Decentered ablations
Central Islands and peninsulas
7. Microkeratome-induced epithelial defects
8. Postoperative pain
9. Postoperative flap complications
Striae
Flap displacement
10. Epithelial growth within the interface
11. Interface debris
12. Regular astigmatism
13. Irregular astigmatism; glare, halos, poor visual quality
14. Overcorrection
15. Undercorrection and regression
16. Corneal ectasia
17. LASIK-induced neurotrophic epitheliopathy
18. Diffuse lamellar keratitis (DLK)
19. Infection
20. Retinal complications