Connective Tissue and Autoimmune Diseases
Most surgeons consider active, uncontrolled connective tissue diseases, such as rheumatoid arthritis, systemic lupus erythematosus, and polyarteritis nodosa, to be contraindications to refractive surgery. Reports in the literature have discussed corneal melting and perforation following cataract extraction in patients with these conditions, as well as corneal scarring after PRK in a patient with systemic lupus erythematosus.
However, 2 retrospective series suggest that refractive surgery may be considered in patients with well-controlled connective tissue or autoimmune disease. One retrospective study of 49 eyes in 26 patients with inactive or stable autoimmune disease who underwent LASIK revealed no postoperative corneal melting or persistent epithelial defects. Another retrospective study of 62 eyes of patients with autoimmune or connective tissue disorders who had undergone LASIK revealed that these eyes had a somewhat worse refractive outcome than eyes of control subjects but did not sustain any severe complications such as corneal melting, laceration, or interface alterations.
Because the risk from an underlying disease cannot be quantified, increased caution should be exercised if refractive surgery is considered in patients with well-controlled autoimmune or connective tissue disease. It should be emphasized that the problems associated with autoimmune diseases may not present for many years, especially with significant ocular surface disease and dry eye. Consultation with the treating physician, unilateral surgery, and ancillary informed consent should be considered.
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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.