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Reasons for candidate exclusion in refractive surgery

Poster Details

First Author: R.Pinto PORTUGAL

Co Author(s):    F. Almeida   F. Fraga   M. Raposo   H. Filipe   A. Carvalho   J. Maia S

Abstract Details


To provide a statistical report of contra-indications for Refractive Surgery (RS) amongst individuals assessed as candidates for this type of procedure in our premises.


Dr Gama Pinto Institute of Ophthalmology in Lisbon, Portugal


This was a retrospective analysis which included 111 individuals (216 eyes) who were assessed as candidates for RS, namely Laser-Assisted In Situ Keratomileusis (LASIK); Phakic Intra-Ocular Lens (IOL) insertion; or clear lens surgery. Patients with a previous diagnosis of ectasic corneal disease were excluded, as were those previously submitted to corneal or intra-ocular surgery. For each RS candidate, the results of the standard screening tests were registered (complete study of refraction; keratometry; pupillometry; ultrasound pachymetry; keratic topography; and, when applicable, specular microscopy and biometry). For each excluded candidate, all intervening factors were recorded.


In our sample, 73.8% of the patients were female, mean age was 32.5 +/- 7.9 years, and mean absolute refractive error was 6.65 + /- 4.72 D. Based on age and refractive error, 61.3% of the individuals were considered for LASIK surgery, 37.8% for phakic IOL insertion and 4.5% for clear lens surgery. Overall, 56.7% of candidates for RS were excluded; these included 63.2% of those considered LASIK surgery, 45.2% of those assessed for phakic IOL insertion and 60.0% of those assessed for clear lens surgery. The most common reasons for candidate failure amongst those considered for LASIK surgery were: insufficient corneal thickness (23.2% of reasons); excessive pupillary diameter and lack of refractive stability (each one representing 16.1% of reasons for exclusion). The main reasons for exclusion amongst phakic IOL surgery candidates were insufficient anterior chamber depth (25.0% of reasons); low endothelial cell count and patient no-show at the appointed time for screening ((each one representing 15.0% of reasons for exclusion). In what regards clear lens procedures, the only grounds for candidate exclusion were low motivation for surgery on the patients“ behalf.


If made available to the general public, this type of information can help to strenghten the notion of how strict the selection process for RS must be. This report also reveals a tendency for LASIK surgery to be the most frequently considered procedure, and for a low pachymetry to be the main reason for candidate failure in this context. On the other hand, this makes alternative techniques such as epi-LASIK and LASEK all the more attractive for these cases. FINANCIAL DISCLOSURE?: No

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