Lasik in a Scarred Eye?

Question

I was diagnosed with keratitis a couple of months ago that has since cleared up, but left a small scar on my right eye. I've read mixed opinions on whether I'd be an ideal candidate for lasik, ranging from "less than ideal" to "disqualified". Does having corneal scarring automatically disqualify me from the operation? If not, what is the safest operation for someone under these conditions?

Christopher Coad, MD · Answer

No.  Depends on your healing.  If laser vision is not an option, possibly Visian or other phobic intraocular lenses may be considered.

Sandy Feldman, MD · Answer

You will need to be examined in order to determine whether you are a candidate for laser vision correction.  Often, PRK or LASIK can be performed but it will depend upon the location, depth and denseness of the scar.  The results of laser vision correction can be excellent in such a situation.  However, if the infection was herpes virus, then, you might not be a candidate for either procedure.

Gary Kawesch, MD (retired) · Answer

There are several issues which need to be considered here.  First, what is the exact cause of the scar?  An injury?  An infection?  If an infection, was it contact-lens related, or was it HSV keratitis (a viral, herpetic keratitis)?  If HSV, you should be aware that corneal refractive surgery can re-activate the virus and lead to more keratitis.  Doesn't mean it can't be done, you just need to be aware of this risk.  Also, LASIK is generally preferred versus PRK in this situation, in that it may be less commonly associated with a re-activation of the virus.  Also, certain medications are often used pre and post-operatively to reduce the risk of this re-activation.

	The location and depth of the scar within the cornea is also important.  If the scar is near the center of the cornea, and affecting vision, often a surface treatment such as PRK is preferred over LASIK since it can remove some or all of the scar.  It depends on how deep within the cornea the scar is, superficial scars are most completely removed.  Deeper scars may be lessened, and vision improved, but may not be completely eliminated with PRK.  With LASIK, the scar will often not be removed much at all, unless it is very deep in the cornea.

	With LASIK, there are two ways to create a flap--using a blade (microkeratome), or using a femtosecond laser such as IntraLase or Ziemer's device.  The laser created flaps typically should NOT be used in the presence of a superficial scar, since the laser beam may be scattered by the scar and an incomplete flap may result.  A blade-based keratome is typically better used in this situation.

	I've treated MANY patients with corneal scars with both PRK and LASIK, and have had great success.

Anthony J. Kameen, MD (retired) · Answer

A corneal scar does not immediately disqualify you from either LASIK or PRK. What determines that is the location of the scar and the depth of the scar in the cornea. Unless the scar is very close to the center of your cornea(the visual axis) then you are still likely a good candidate. You need a good eye exam, corneal measurements and counsel from an experienced laser refractive surgeon.....then you will know if you are a candidate or not. In fact, many times we are able to lessen or eliminate the scar by using the laser, so don't give up hope!

Lasik in a Scarred Eye?

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Lasik in a Scarred Eye?

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