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Observational Study
. 2019 Nov;45(11):1612-1618.
doi: 10.1016/j.jcrs.2019.06.017. Epub 2019 Oct 1.

Refractive surgery in the HIV-positive U.S. Military Natural History Study Cohort: complications and risk factors

Carter S Tisdale  1 , Grant A Justin  2 , Xun Wang  3 , Xiuping Chu  3 , Darrel K Carlton  4 , Jason F Okulicz  5 , Christina Schofield  6 , Ryan C Maves  7 , Brian K Agan  3 , Gary L Legault  4 ; Infectious Disease Clinical Research Program HIV Working Group
Collaborators, Affiliations
Observational Study

Refractive surgery in the HIV-positive U.S. Military Natural History Study Cohort: complications and risk factors

Carter S Tisdale et al. J Cataract Refract Surg. 2019 Nov.

Abstract

Purpose: This study sought to assess the frequency of refractive surgery complications in HIV+ individuals and related risk factors.

Settings: Multiple centers in the United States.

Design: Prospective observational cohort study.

Methods: The U.S. Military HIV Natural History Study is a prospective observational cohort study of HIV+ service members and beneficiaries. Participants were selected who had Current Procedural Terminology codes for laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and other refractive surgeries. The frequency of complications was determined using International Classification of Diseases-9 codes. Covariates included age, sex, antiretroviral therapy, time since HIV diagnosis, history of AIDS, and CD4 (T lymphocytes) count and viral load. Statistical analysis was completed using univariate (χ2 and Wilcoxon-Mann-Whitney tests) and multivariate analyses.

Results: Seventy-nine of 2073 participants had refractive surgery. Fifty-three patients underwent PRK, 23 LASIK, 2 radial keratotomy (RK), and 1 astigmatic correction. Complications occurred in 6 (7.6%) of 79 participants, including 5 patients who underwent PRK and 1 after RK, occurring between 8 and 217 days after surgery. Five ulcers and 1 unspecified keratitis were noted. In the univariate analysis, type of surgery (P = .02) and history of AIDS (P = .02) were risk factors for complications. In logistic regression analysis, no variables were found to be risk factors for complications.

Conclusion: Complications were infrequent among HIV+ participants after refractive surgery. Point estimates suggest that PRK might have more complications than LASIK and that advanced HIV, reflected by previous AIDS, might be associated with an increased risk for complications. Further study will be required to confirm these findings.

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Conflict of interest statement

Conflict of Interest: No conflicting relationship exists for any author

Figures

Figure 1:
Figure 1:
Flow Chart of Subject Selection
Figure 2:
Figure 2:
Incidence of Refractive Surgery
See this image and copyright information in PMC

References

    1. Marcus J, Chao C, Leyden WA, et al. Narrowing the Gap in Life Expectancy for HIV+ Compared with HIV− Individuals. CROI; Boston Massachusetts: 2016. Abstract #54.
    1. “Refractive Errors & Refractive Surgery Preferred Practice Pattern.” American Academy of Ophthalmology. 9 September 2017.
    1. Hovanesian JA, Faktorovich EG, Hoffbauer JD, et al. Bilateral bacterial keratitis after laser in situ keratomileusis in a patient with human immunodeficiency virus infection. Arch Ophthalmol. 1999; 117:968–70. - PubMed
    1. Aref AA, Scott IU, Zerfoss EL, Kunselman AR. Refractive surgical practices in persons with human immunodeficiency virus positivity or acquired immune deficiency syndrome. J Cataract Refract Surg. 2010; 36:153–60. - PubMed
    1. Ganesan A, Landrum ML, Chun H, et al. Outcomes of highly active antiretroviral therapy in the context of universal access to healthcare: the U.S. Military HIV Natural History Study. AIDS Research and Therapy 2010; 7(1): 14. - PMC - PubMed

Other Cited Material

    1. “HIV/AIDS.” World Health Organization, 19 July 2018, www.who.int/en/news-room/fact-sheets/detail/hiv-aids.
    1. “When is LASIK not for me?” U.S. Food & Drug Administration, 11 July 2018, https://www.fda.gov/medicaldevices/productsandmedicalprocedures/surgerya....
    1. “Perioperative Management” New York State Department of Health AIDS Institute, January 2012, https://www.hivguidelines.org/hiv-care/perioperative-management/.

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