Update on contraindications for laser-assisted in situ keratomileusis and photorefractive keratectomy

Laser refractive surgery (LRS) is one of the most common elective procedures performed in the USA today. Patients should be rigorously screened for certain ocular and systemic conditions, which may represent contraindications to LRS. Before treating, the refractive surgeon should be aware of the Food and Drug Administration (FDA) labeling for the procedure as well as what other evidence, such as clinical studies, case series, cases reports, and anecdotal evidence, exists. The purpose of this article is to review contraindications to having LRS.

Ocular contraindications to LRS include unstable refractive error, corneal ectatic disorders, a history of herpetic keratitis, Avellino corneal dystrophy, significant cataract, and uncontrolled glaucoma. LRS should also be avoided in uncontrolled diabetes, collagen vascular disease (CVD), pregnancy, and in patients taking amiodarone and isotretinoin.

Current contraindicatisons to LRS are based on FDA labeling and guidelines from the American Academy of Ophthalmology. Much of the evidence is based on case reports or series, anecdotal evidence, or known complications from nonlaser ocular surgery. More randomized clinical trials are needed to establish the safety of LRS in controversial conditions such as well controlled CVD.