LASIK may be considered in some patients with well-controlled or inactive autoimmune diseases

Las Vegas-LASIK may be reasonable in patients with well-controlled or inactive autoimmune disease who are otherwise good candidates for refractive surgery, according to Ronald J. Smith, MD, who presented the findings on autoimmune disease and LASIK in a refractive surgery subspecialty day presentation at the American Academy of Ophthalmology annual meeting.

The FDA labels the broad class of autoimmune disease as a contraindication to LASIK regardless of the severity of disease. Evidence to support this position, however, is limited, because no prospective clinical trials have included patients with autoimmune disease, said Dr. Smith, of Beverly Hills Vision and Laser Institute, Beverly Hills, CA.

The literature includes one published report of a patient with lupus who experienced a corneal melt following PRK, as well as case reports and case series recounting corneal or scleral melts that developed following cataract surgery.

To study this question, he and co-investigator Robert Maloney, MD, of the Maloney Vision Institute in Los Angeles, conducted a retrospective review of patients who underwent LASIK from June 1, 1998, to October 1, 2004, at the Maloney Vision Institute. They reviewed the records for the presence of autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, scleroderma, inflammatory bowel disease, Graves' disease, Reiter's syndrome, and Hashimoto's thyroiditis and looked for signs of scleral and corneal complications of these diseases following LASIK.

The review found 49 eyes of 26 patients with autoimmune diseases, most commonly lupus and rheumatoid arthritis.

"None of our patients developed any of the corneal scleral complications," Dr. Smith said. "There were no corneal melts, no Stage IV or central toxic keratopathy, no persistent epithelial defect, and no scleral melts."

Analysis of refractive outcomes did not include dry eye or self-limited diffuse lamellar keratitis because of their prevalence in the normal LASIK population.

Other published results

The results of this study are similar to two other recent studies, Dr. Smith said. In a study published in the journal Ophthalmology in 2006, Rosario Cobo-Sariano, MD, and colleagues conducted an observational case-control study to determine the anatomic and functional outcomes of LASIK in patients with underlying systemic diseases that are traditionally listed as relative or absolute contraindications.

The case groups were composed of 275 eyes of 141 consecutive patients who underwent LASIK and had underlying conditions such as autoimmune connective-tissue disorders, psoriasis, intestinal inflammatory disease, diabetes mellitus, and history of keloid formation. The control group consisted of 358 eyes of 181 patients without any underlying conditions who also underwent LASIK.

Similar percentages of mild anatomic complications were observed in both groups. The only significant functional finding was a worse refractive outcome in individuals with collagen vascular diseases.

The authors concluded that LASIK could be performed safely and effectively in selected individuals with stable, controlled systemic diseases.

In another study, published in Ophthalmology in 2005, Jorge Alio, MD, and colleagues conducted a retrospective consecutive observational clinical study in 42 eyes of 22 patients who had a history of rheumatic disease and had undergone LASIK. All patients had a history of controlled rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, scleroderma, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, arthritis, or Behcet's disease.

Assessments were made preoperatively and at 1, 3, and 6 months postoperatively. A favorable postoperative visual outcome was obtained with no operative or postoperative vision-threatening complications such as corneal haze, melting, flap, or interface complications.