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LASIK Risk Score: An Easy Method to Predict Postoperative Outcome PURPOSE: To present a simple model for assessing the risk score of laser in situ keratomileusis (LASIK).
METHODS: The LASIK surgery risk score is a number attributed to every LASIK procedure and depends on the presence of individual variables that might add diffi culty and increase the risk of the RESULTS: The score can vary from 1 to 14 with values between 1 and 4 considered low risk for complications, values between 5 and 9 moderate risk, and values above 10 high risk.
CONCLUSIONS: This scale gives a gross estimate of the surgical risk of the LASIK procedure and adds valuable information to the preoperative assessment. [J Refract Surg. 2005;21:399-400.] Laser in situ keratomileusis (LASIK) has become an History of complications in fellow eye increasingly performed procedure throughout the world. Predicting surgical outcome, as with any other type of surgery, often is a diffi cult task especially when multiple preoperative risk factors coexist. None-theless, patients’ satisfaction is intimately related to the expectations they build during their preoperative visit. Patients usually expect their surgeon to provide them with a number or a percentage of success for their sur- K = corneal curvature (K reading) in diopters gery, which may not always be available. This is espe-cially true when numerous variables may affect the sur-gical result such as in LASIK. Various scores have been the fellow eye, large pupil size, presence of anterior devised in the different subspecialties of medicine to basement membrane dystrophy, dry eyes, and smaller estimate the risk of surgical procedures and predict the optical zone5-8 (Table). The score can vary from 1 to 14 postoperative outcome.1-4 A simple model for assessing with values between 1 and 4 considered low risk for the risk score of LASIK surgery is presented.
complications, values between 5 and 9 moderate risk, The LASIK surgery risk score is a number attributed to every LASIK procedure and depends on the pres- The advantage of the LASIK risk score is that it ence of individual variables that might add diffi culty gives the ophthalmologist and patient an objective and increase the risk of the surgical procedure. Such preoperative assessment of the risk of the procedure. variables include higher amounts of refraction, pres- In addition, it directs the surgeon’s attention to details ence of hyperopia or astigmatism, increasing age, fl at- in the ocular examination that might be easily over- ter preoperative corneal curvature, whether the proce- looked such as the presence of dry eyes and anterior dure is an enhancement, history of complications in basement membrane dystrophy. Scores from different procedures can also be compared, and the scale can be From the Department of Ophthalmology, University of Minnesota modifi ed to include additional risk factors, or the num- Medical Center, Minneapolis, Minn. bers attributed to each risk can be modifi ed according The author has no proprietary interest in the materials presented This scale gives a gross estimate of the surgical risk Correspondence: Dany M. Najjar, MD, Dept of Ophthalmology, Mayo of the LASIK procedure and adds valuable informa- Mail Code 493, 420 Delaware St SE, Minneapolis, MN 55455. Tel: tion to the preoperative assessment. Future prospec- 612.625.4400; Fax: 612.626.3119; E-mail: danynajjar@hotmail.com tive studies using multivariate regression analyses can be performed to validate this scale and offer patients a more accurate measure of the risk of LASIK surgery.
Journal of Refractive Surgery Volume 21 July/August 2005 tory of herpetic eye disease can present with this complication. 1. Ochiai T, Hiranuma S, Takiguchi N, Ito K, Kawaguchi A, Iwai Oral antiviral prophylaxis may be appropriate when performing T, Arii S. SOFA score predicts postoperative outcome of pa- LASIK on patients with a history of ocular or systemic HSV in- tients with colorectal perforation. Hepatogastroenterology. fection. [J Refract Surg. 2005;21:400-402.] 2. Donati A, Ruzzi M, Adrario E, Pelaia P, Coluzzi F, Gabbanelli V, Pietropaoli P. A new and feasible model for predicting opera-tive risk. Br J Anaesth. 2004;93:393-399.
Controversy exists regarding the potential triggers of recurrent ocular herpes simplex virus (HSV) 3. Stallings SP, Paling JE. New tool for presenting risk in obstet- disease,1 including upper respiratory tract in- rics and gynecology. Obstet Gynecol. 2001;98:345-349.
fection, fever, seasonal conditions, and psychological 4. Najjar DM, Awwad ST. Cataract surgery risk score for residents stress. Eye trauma, including refractive procedures, has and beginning surgeons. J Cataract Refract Surg. 2003;29:2036-2037.
also been proposed for this potential triggering effect. 5. Bailey MD, Mitchell GL, Dhaliwal DK, Boxer Wachler BS, Zad- In animal models, reactivation of latent HSV has been nik K. Patient satisfaction and visual symptoms after laser in described following excimer laser photokeratectomy2,3 situ keratomileusis. Ophthalmology. 2003;110:1371-1378.
and laser in situ keratomileusis (LASIK).4 In humans, 6. Randleman JB, Russell B, Ward MA, Thompson KP, Stulting only three cases of reactivated HSV following LASIK RD. Risk factors and prognosis for corneal ectasia after LASIK. Ophthalmology. 2003;110:267-275.
We present two cases of HSV keratitis following 7. Pop M, Payette Y. Risk factors for night vision after LASIK for myopia. Ophthalmology. 2004;111:3-10.
LASIK in two patients with previous herpes labialis 8. Hammond SD Jr, Puri AK, Ambati BK. Quality of vision and patient and herpetic eye disease, respectively.
satisfaction after LASIK. Curr Opin Ophthalmol. 2004;15:328-332.
A 32-year-old woman underwent bilateral LASIK for myopia. Preoperative refraction was Ϫ4.25 Ϫ1.75 ϫ 13° in the right eye and Ϫ4.25 Ϫ1.50 ϫ 8° in the left eye. Uncorrected visual acuity (UCVA) was 6/120 in both eyes. Best spectacle-corrected visual acuity was 6/6 in both eyes. Ocular history was positive for herpes la-bialis. Slit-lamp examination of anterior and posterior PURPOSE: To report two cases of herpes simplex virus (HSV) segments was normal. Cornea was completely clear bi- keratitis after laser in situ keratomileusis (LASIK).
Laser in situ keratomileusis was performed with METHODS: Interventional small case series. Two patients under-went uneventful LASIK. History of herpes labialis in one patient and the Nidek EC-5000 excimer laser (Nidek Technolo- herpetic eye disease Ͼ10 years prior to intervention in the other gies, Gamagori, Japan) after a nasally hinged 160-µm patient was reported. Both patients developed stromal herpetic fl ap was made by the Nidek 2000-MK microkeratome keratitis 6 weeks and 2 years after the procedure, respectively.
with an 8.5-mm suction ring. The laser procedure was not performed in the left eye because buttonhole for- RESULTS: Treatment consisting of topical steroid drops and topi- cal and systemic antiviral therapy was administered. Recurrences of the herpetic keratitis were seen after tapering of the topical One day postoperatively, UCVA was 6/15 in the steroids; four and three recurrences were observed, respectively. right eye, and the fl ap was clear. Dexamethasone and Final visual acuity was Ͼ6/9 in both cases.
chloramphenicol drops four times a day were started. Six weeks after the procedure and while on dexameth- CONCLUSIONS: Herpetic keratitis after LASIK is an uncom- asone drops twice daily, the patient reported reduced mon, possibly under-reported, entity. Even patients without his- vision in her right eye. Uncorrected visual acuity was From the Ophthalmology Department, Soroka University Medical 6/24. Slit-lamp examination revealed edema of the Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. inferior cornea and keratic precipitates on the endo- The authors have no proprietary interest in the materials presented thelium (Fig). Signifi cant irregular astigmatism was observed on corneal computerized keratopography. Correspondence: Jaime Levy, MD, Dept of Ophthalmology, Soroka Steroid drops were prescribed eight times a day. Be- University Medical Center, PO Box 151, Beer-Sheva 84101, Israel. cause slow improvement was observed, primary HSV Tel: 972 8 6400379; Fax: 972 8 6403927; E-mail: ljaime@bgu.ac.il disciform keratitis was not suspected and antiviral therapy was not started. One month later, epithelial dendrites appeared, and acyclovir ointment fi ve times

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