The medical history should include systemic conditions, prior surgical procedures, and current and prior medications. Certain systemic conditions, such as connective tissue disorders and diabetes mellitus, can lead to poor healing after refractive surgery. An immunocompromised state—for example, from cancer or human immunodeficiency virus infection and acquired immunodeficiency syndrome—may increase the risk of infection after refractive surgery (see Chapter 10). Medications that affect healing or the ability to fight infection, such as systemic corticosteroids or chemotherapeutic drugs, should be specifically noted. The use of corticosteroids increases the risk of cataract development, which could compromise the long-term postoperative visual outcome. Use of certain medications—for example, isotretinoin and amiodarone—traditionally has been thought to increase the risk of poor results with photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) due to a potentially increased risk of poor corneal healing; however, there is no evidence for this association in the peer-reviewed literature. Previous use of isotretinoin can damage the meibomian glands and predispose a patient to dry-eye symptoms postoperatively. Because of a possible increased risk of delayed epithelial healing, caution needs to be taken with patients using sumatriptan who are undergoing PRK or LASIK and with patients using hormone replacement therapy or antihistamines who are undergoing PRK.
Although laser manufacturers do not recommend excimer laser surgery for patients with cardiac pacemakers and implanted defibrillators, many such patients have undergone the surgery without problems. It may be best to check with the pacemaker and defibrillator manufacturer before laser surgery. Refractive surgery is also generally contraindicated in pregnant and breastfeeding women because of possible changes in refraction and corneal hydration status. Many surgeons recommend waiting at least 3 months after delivery and cessation of breastfeeding before performing the refractive surgery evaluation and procedure.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.