Inflammatory Bowel Disease Guidelines for Corneal Refractive Surgery Evaluation

Abstract

Inflammatory bowel disease (IBD) is a chronic systemic inflammatory condition that can potentially adversely affect surgical outcomes in patients receiving elective ophthalmic procedures. In this case series, 21 eyes of 11 patients with ulcerative colitis or Crohn’s disease underwent laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), or small incision lenticule extraction (SMILE). Their surgical outcomes were followed up for an average of 8.9 ± 4.6 months. All the patients in this study did well, with 100% of eyes corrected for distance vision achieving uncorrected distance visual acuity 20/20 by postoperative month three. Common symptoms noted during the postoperative period included dry eyes, irritation, foreign body sensation, and blurry vision, all of which improved in prevalence and severity over the follow-up period, and none of the patients experienced a flare-up of their disease. Despite the successful outcomes in these patients, the authors recognize the inherent risks of operating on patients with IBD. Currently, there are no consensus guidelines for clinicians to follow to ensure that they are adequately screening these patients for eligibility, so the authors are suggesting a relevant, focused review of systems, a brief IBD history-related questionnaire, and a preliminary surgical decision-making flowchart for use in surgical evaluation.

Systemic contraindications for laser vision correction – an overview

“…Dry eye symptoms are also not uncommon in these patients due to fat-soluble vitamin deficiencies. The LVC is relatively contraindicated in IBD [3,9,16]. The LASIK surgery is relatively possible in well controlled stage of the disease, while in exacerbation of the IBD, the immune response may result in unfortunate complications such as necrotizing keratitis [16,17].…”

“…The LVC is relatively contraindicated in IBD [3,9,16]. The LASIK surgery is relatively possible in well controlled stage of the disease, while in exacerbation of the IBD, the immune response may result in unfortunate complications such as necrotizing keratitis [16,17]. Immunomodulating medication use, in the management of IBD, such as azathioprine, tacrolimus and methotrexate does not constitute a contraindication for LVC.…”

“…However, immunosuppression poses the risk of post-surgical herpes simplex virus or Varicella-Zoster virus infections, therefore acyclovir should be considered in perioperative prophylaxis. As it has been reported that the IBD have a strong association with keratoconus, the corneal topography should be carefully analysed in planning the LVS surgery in those patients [9,16].…”

Magnetocaloric‐Responsive Hydrogel Nanoarchitectonics for Pyroptosis‐Relay‐Immunotherapy to Suppress Post‐Operation Tumor Recurrence and Metastasis

“…However, immunotherapy still faces significant challenges, including long-acting immune stimulation impediment [12] and inflammatory irritation after surgery. [13] Researchers often focus on reshaping the tumor microenvironment (TME) [14] to boost the immune response to balance the complexity between malignant cells and the immune defense system. [15] Emerging evidence has indicated that pyroptosis [16] could reactivate the immune system and enhance tumor immunogenicity.…”

“…However, immunotherapy still faces significant challenges, including long‐acting immune stimulation impediment [ 12 ] and inflammatory irritation after surgery. [ 13 ]…”