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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
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: firstname.lastname@example.org
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
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
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
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
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
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.
We present two cases of HSV keratitis following
7. Pop M, Payette Y. Risk factors for night vision after LASIK for
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
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: email@example.com
disciform keratitis was not suspected and antiviral
therapy was not started. One month later, epithelial
dendrites appeared, and acyclovir ointment ﬁ ve times
Letters in Applied Microbiology ISSN 0266-8254Modified nitrocefin-EDTA method to differentially quantifythe induced L1 and L2 b-lactamases in StenotrophomonasmaltophiliaR.-M. Hu1, K.-H. Chiang2, C.-W. Lin2 and T.-C. Yang21 Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan2 Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichu
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