Transient light sensitivity after femtosecond laser flap creation: clinical findings and management

To describe the constellation of subjective and objective findings associated with unusual occurrences of photosensitivity after laser in situ keratomileusis (LASIK) with femtosecond flap creation and identify optimal management strategies.

Demographic data, laser settings, subjective complaints, clinical findings, treatment, and response to treatment were recorded for suspected cases of transient postoperative photosensitivity from 3 surgeons operating at 3 different sites. All cases were estimated for the period covering the suspected cases at each site to assess incidence. Additional cases were solicited from IntraLase users via a survey.

For the 3 sites, 63 eyes from 33 patients were reported of a total estimated case log of 5667 (incidence, 1.1%). Average age was 41 years, and 51.7% of patients were women. Onset of symptoms ranged from 2 to 6 weeks after uneventful LASIK. All patients were treated with prednisolone acetate drops, whereas 1 surgeon also used Restasis (cyclosporine ophthalmic solution 0.05%). Patients noted improvement of symptoms within 1 week of treatment. When the raster and side-cut energy settings were lowered (by an average of 24% and 33%, respectively), significant reductions in incidence were noted. Similar findings were reported by 3 additional surgeons reporting 17 cases in the survey of IntraLase users.

This report describes a new complication of LASIK performed with a femtosecond laser keratome that may be related to the pulse energy used for flap creation. Although there is no loss of uncorrected visual acuity, symptoms can be prolonged, especially without prompt steroid therapy. Technical advances that reduced pulse energies appear to decrease the incidence.