Causes for Rejection of Keratorefractive Surgery in a Central Indian Population

Abstract

To identify the reasons for refusing refractive surgery in patients visiting for spectacle-free vision. MethodologyMedical records of 296 patients who presented for keratorefractive surgery (KRS) from June 2017 to April 2020 at a tertiary eye care center in central India (Government Medical College and Hospital, Nagpur, Maharashtra, India) were reviewed. Demographic details of all the patients and parameters obtained during workup of a case presented for KRSs were captured in an Excel ® sheet and analyzed statistically. ResultsOf the 296 patients who presented for KRS during the study period, 86 (29.1%) patients were denied KRS. The mean pachymetry in the right eye was 505 μm ± 10 μm (range 520-485 μm) and 502 μm ± 7 μm (511-490 μm) in the left eye. Suboptimal corneal thickness (n = 28, 32.6%) was the most common reason for rejection. Other reasons for not recommending the procedure were high myopia (n = 20, 23.3%), spectacle not stable (n = 16, 18.6%), and keratoconus (n = 11, 12.8%). Collagen vascular diseases (n = 3, 3.5%) and anxiety about the procedure (n = 2, 2.3%) were causes unrelated to the procedure. No correlation was observed between corneal thickness and degree of myopia (r = 0.014, p = 0.66). ConclusionPatients presenting for KRS exhibit various problems. Meticulous preoperative evaluation is most important for long-term visual outcome. Suboptimal corneal thickness, high myopia, unstable spectacle correction, and keratoconus were the common reasons for not performing KRS in the study population.

Reasons for declining corneal refractive laser correction for refractive candidates in Southern India

“…Our observation of KC as the reason for rejection was 12.9%. Around nine previous studies[ 6 7 8 9 10 11 12 13 14 ] were performed in the literature on our topic of interest. Hashmani S et al , studied reasons for not performing LASIK in 6005 eyes, observed unfit topography as the common cause in 29.75% and KC in 14.93% eyes[ 9 ].…”

“…Josh et al . [ 14 ] identified the reasons for refusing LASIK among the patients attending the Government hospital, Nagpur, between 2017 and 2020. Among 296 patients, only 86 were rejected (29.1%); the rejection rate was similar to the previous studies 21–34% and observed low CCT (32.6%) as the cause for rejection was the most common reason, unstable refraction in 18.6%, high myopia in 23.3%, keratoconus in 12.8%, herpetic keratitis 7%, collagen vascular diseases in 3.5%, and anxiety in 2.3%.…”

“…Similarly, Joshi observed mean pachymetry of 505 um in the right eye and 502 um in the left eye. [ 14 ] LASIK in thin corneas would lead to the risk of developing ectasia. Rarely, few studies have noted cataracts as the cause for rejection, 5.7% in Japan,[ 4 ] 11.4% in Yemen,[ 8 ] 9.7%[ 13 ] in the USA, Cleveland, and 1.5% in our study.…”