Complications and challenges of refractive surgery

PURPOSE OF REVIEW: This review provides an overview of possible complications of the most commonly performed refractive surgeries: laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), small incision lenticule extraction (SMILE), and lens-based refractive surgery. While the vast majority of refractive surgeries are safe with successful outcomes, complications can still occur which requires surgeons to have an in-depth understanding of complication prevention and management. RECENT FINDINGS: Although overall rare, corneal laser refractive procedures and lens-based refractive surgeries are associated with a distinct set of potential complications. The most common complications from LASIK, PRK, and SMILE include flap issues, infectious keratitis, haze, dry eye disease, and corneal ectasia. Implantable collamer lenses (ICLs) come with a possible risk of intraocular pressure elevation and cataract formation. Refractive lens exchange (RLE) introduces younger patients to potential complications typically associated with cataract surgery, such as dysphotopsias, uveitis, and retinal detachment. SUMMARY: The elective nature of refractive surgery may raise expectations of patients for successful outcomes. This timely review provides relevant and detailed guidance to refractive surgeons on best practices to mitigate potential complications, and ultimately maximize patient safety and satisfaction.