Safety and efficacy of keratorefractive surgery in diabetes mellitus: A clinical review

Keratorefractive surgery is typically performed to correct refractive errors, resulting in good postoperative outcomes. Certain conditions, such as autoimmune diseases, metabolic diseases like diabetes mellitus (DM), and the use of some drugs, may be absolutely or relatively contraindicated for refractive surgery. DM is a multisystemic disorder affecting various organs and can result in retinopathy, nephropathy, and neuropathy. Persistent hyperglycemia leads to various pathophysiological changes that can alter the biomechanical profile and the wound healing process of the cornea. Proper patient counselling, optimizing blood glucose levels, and frequent follow-up visits to monitor and manage potential complications, such as dry eye, non-healing epithelial defects, and neurotrophic keratitis, are essential for refractive surgeons. Laser-assisted in situ keratomileusis is preferred over photorefractive keratectomy due to its faster healing process. Cataract surgery in people with diabetes warrants various preoperative, intraoperative, and postoperative considerations for the best visual outcomes. This review focuses on the current evidence pertaining to various structural and functional corneal changes occurring in diabetics and their impact on keratorefractive procedures, thus providing a unified, clinically oriented framework to guide refractive surgeons in risk stratification, procedure selection, and postoperative management in patients with DM.