From the Guidelines
The current complication rate of LASIK surgery is generally low, with serious complications occurring in less than 1% of cases, as reported in the most recent study from 2023 1.
Overview of LASIK Complications
The risk of complications varies based on individual factors such as corneal thickness, refractive error severity, and pre-existing conditions. Minor complications such as dry eye, glare, halos, and fluctuating vision occur more frequently, affecting approximately 10-20% of patients, though these typically resolve within 3-6 months after surgery.
Specific Complications
Specific complications include:
- Dry eye syndrome (affecting up to 20% of patients temporarily)
- Infection (less than 0.1%)
- Flap complications (0.3-5.7%)
- Epithelial ingrowth (1-2%)
- Diffuse lamellar keratitis (1-4%)
- Ectasia (0.04-0.6%)
Modern LASIK Techniques
Modern LASIK techniques including wavefront-guided and femtosecond laser technologies have contributed to improved safety profiles compared to earlier procedures, as noted in the refractive surgery preferred practice pattern 1.
Pre-operative Screening
Patients should undergo comprehensive pre-operative screening to identify risk factors that might increase complication rates, and should be aware that while most complications are temporary, some may require additional treatment or could result in permanent visual changes, as highlighted in the special considerations for evaluating patients for LASIK 1.
Management of Complications
Management options for complications such as ectasia after LASIK include contact lenses, corneal cross-linking (CXL), and intrastromal corneal ring segments (ICRS), with corneal transplantation being an option in severe cases, as discussed in the context of corneal ectasia 1.
From the Research
Complication Rates of LASIK
The current complication rate of Laser-Assisted In Situ Keratomileusis (LASIK) is not explicitly stated as 1% in the provided studies. However, the studies do report various complication rates:
- A study from 1998 2 reports that the most serious complication occurred in three eyes with preoperative high hyperopia, resulting in corneal topographic abnormalities. Loss of spectacle-corrected visual acuity of two or more lines occurred in five eyes (3%).
- A study from 2006 3 found that there were no statistically significant differences between fellow and faculty cases with respect to complication rates and final visual outcomes. However, fellows were significantly more likely to experience microkeratome-related flap complications during their first 25 cases (4.8% vs 1.2%).
- A study from 1998 4 reviews common complications of LASIK, including flap irregularities, epithelium and other materials within the lamellar interface, irregular astigmatism, regular astigmatism, regression, and overcorrection. Infection is noted as a rare but potentially serious complication.
- A study from 2011 5 reports that dry eyes are the most common complication of LASIK, with virtually all patients developing some degree of dryness in the immediate postoperative period.
Key Findings
- The complication rates of LASIK vary depending on the study and the specific complications being reported.
- Dry eyes are a common complication of LASIK, with virtually all patients developing some degree of dryness in the immediate postoperative period 5.
- Loss of spectacle-corrected visual acuity of two or more lines occurred in five eyes (3%) in one study 2.
- Microkeratome-related flap complications were more likely to occur during a fellow's first 25 cases (4.8% vs 1.2%) 3.
Complications Reported
- Corneal flap abnormalities
- Epithelial ingrowth
- Corneal ectasia
- Infectious keratitis
- Dry eyes
- Diffuse lamellar keratitis
- Flap irregularities
- Epithelium and other materials within the lamellar interface
- Irregular astigmatism
- Regular astigmatism
- Regression
- Overcorrection
- Infection