LASIK may be OK for some autoimmune patients

Although the FDA considers autoimmune diseases a contraindication for LASIK regardless of disease severity, a retrospective study suggests that the surgery may be appropriate in patients with well-controlled or inactive disease, said Ronald J. Smith, MD, MPH, of Beverly Hills.

There have been no prospective clinical trials that have included patients with autoimmune diseases, although one case report cited a patient with lupus who developed corneal melt following PRK. Conflicting evidence has emerged from reports of cataract surgery on patients with autoimmune disease. However, this evidence should not necessarily be generalized to all patients with autoimmune diseases who are considering refractive surgery, Dr. Smith said.

He and colleague Robert Maloney, MD, of Los Angeles, conducted a retrospective analysis of patients undergoing LASIK at the Maloney Vision Institute, reviewing records for a history of any autoimmune disease. They identified 49 eyes of 26 patients with an autoimmune disease, most commonly lupus or rheumatoid arthritis. In all cases, the disease was inactive or the patients were stable on medication.

"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 defects, and no scleral melts."

These results were similar to the findings of several other recent studies.

"LASIK may be reasonable in patients with well-controlled or inactive autoimmune disease who are otherwise good candidates for LASIK," Dr. Smith said. He added that proper informed consent must be obtained.