title: Survey of complications and recommendations for management in dissatisfied patients seeking a consultation after refractive surgery.
abstract: OBJECTIVE
  To review complications associated with and management options for dissatisfied patients seeking a consultation after refractive surgery performed elsewhere.
  
  
  METHODS
  Refractive Eye Surgery Center, The Wilmer Institute, Lutherville, Maryland, USA.
  
  
  METHODS
  In this retrospective review, charts of consecutive dissatisfied patients who sought a refractive consultation between June 1999 and January 2003 after refractive surgery performed elsewhere were reviewed and the following parameters were analyzed: visual acuity (uncorrected and best spectacle corrected), prior manifest refraction, complications, and recommendations. The subjective complaints, complications, and visual acuity were reviewed, and the associated historical or visual risk factors as well as treatment options were analyzed.
  
  
  RESULTS
  One hundred sixty-one eyes in 101 patients with ocular complaints were identified. One hundred thirty-four eyes (83.2%) had had laser in situ keratomileusis; 22 eyes, photorefractive keratectomy; 4 eyes, radial keratotomy; and 1 eye, laser thermokeratoplasty. The most common subjective complaints were blurred distance vision (59.0%), glare and night-vision disturbances (43.5%), and dry eyes (21.1%). The most common complications were overcorrection (30.4%), irregular astigmatism (29.8%), dry eyes (29.8%), glare (26.1%), difficulty with night driving (16.7%), and corneal haze (16.7%). The most common cause identified in eyes with best spectacle-corrected visual acuity worse than 20/40 was irregular astigmatism (10 of 18 eyes [55.5%]). The most common recommendation for management was medical treatment or observation (68.3%). Medical therapies recommended included lubrication, punctal plugs, topical and systemic pharmaceutical agents to modulate ocular surface, spectacles, and contact lenses. Keratoplasty (lamellar or penetrating) was recommended in 4 patients (4 eyes [2.5%]). The diagnoses included corneal ectasia in 3 eyes and severe flap complication with irregular astigmatism in 1 eye. Nine patients (5.6% eyes) required nonkeratoplasty surgery. In other patients, waiting for advances in technology, including wavefront-guided customized retreatment, was recommended.
  
  
  CONCLUSIONS
  A spectrum of complications associated with refractive surgery may result in patient dissatisfaction. Proper patient selection, prevention strategies, and prompt diagnosis and medical or surgical intervention may be beneficial in managing complications and improving patient satisfaction.
authors.affiliation: Refractive Eye Surgery Service, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21093, USA. nsjabbur@jhmi.edu
authors.forename: Nada S
authors.initials: NS
authors.lastname: Jabbur
authors.forename: Keiko
authors.initials: K
authors.lastname: Sakatani
authors.forename: Terrence P
authors.initials: TP
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D000368:Aged; D015352:Dry Eye Syndromes / Q000209:etiology / Q000628:therapy*; D005260:Female; D006306:Health Surveys; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D007646:Keratotomy, Radial; D017075:Laser Coagulation; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018903:Photorefractive Keratectomy; D011183:Postoperative Complications; D012017:Referral and Consultation; D054140:Refractive Surgical Procedures; D012189:Retrospective Studies; D014786:Vision Disorders / Q000209:etiology / Q000628:therapy*; D014792:Visual Acuity