Eyeworld

34 | EYEWORLD | AUGUST 2020 R EFRACTIVE Contact Legault: gary.l.legault.mil@mail.mil by Maxine Lipner Contributing Writer I ndividuals who are HIV positive can safely undergo LASIK and PRK, according to a study published in the Journal of Cataract & Refractive Surgery. 1 "I wanted to know if it was safe [to conduct] refractive surgery on people with HIV," said Gary Legault, MD, one of the study authors. In the study, which drew upon information from the Uniformed Services University database, investigators retrospec- tively considered outcomes of LASIK, PRK, or RK among service members who were HIV positive. Of these patients, 53 had PRK, 23 had LASIK, and two had RK. Outcomes depended somewhat on the type of refractive surgery, Dr. Legault said, but overall, the study found it safe for patients with HIV to have LASIK. "There were no complica- tions for any of the patients who had LASIK," he said. There were five complications among those who had PRK and one involving RK. Complications included five corneal ulcers and one unspecified keratitis. Dr. Legault said it makes sense that PRK might pose more of a risk to patients with HIV, due to its prolonged epithelial defect and epithelial barrier breakdown. He was a bit surprised, however, that complications seemed to be delayed, occurring between 8–217 days after surgery. "I was expecting them to be more acute right after the surgery," Dr. Legault said. Advanced HIV status also seemed related to complication risk. Those with higher viral loads of up to 36,000 were more likely to have complications. "When their viral load picks up or their CD4 count goes down, they're at risk for more infections," Dr. Legault said, noting that there were a couple of patients with lower viral loads (1,700 or 2,500) who experienced complications. Based on these findings, the study authors suggest that LASIK might be a safer refractive surgery for patients with HIV. "It's also important you work with your infectious disease consultant to make sure that the patient's viral load is below 10,000 and that their CD4 count is not below 200," Dr. Legault said, adding that others have used a 300 or 400 CD4 count as the cutoff. Dr. Legault said there is no evidence to sug- gest disease transmission risk when performing refractive surgery on this patient population. At this point that risk is theoretical. While normal sterilization measures should be sufficient, he advised use of disposable instruments. Overall, Dr. Legault doesn't view HIV-pos- itive status as a contraindication for refractive surgery. "I think that HIV-positive patients are relatively safe to have refractive surgery and shouldn't be automatically disqualified," he said. "However, you need to work with your infec- tious disease specialists to ensure that the CD4 count is adequate and the viral load isn't too high." Refractive surgery and HIV About the doctor Gary Legault, MD Ophthalmology residency program director Brooke Army Medical Center Fort Sam Houston, Texas Reference 1. Tisdale CS, et al. Refractive surgery in the HIV-positive U.S. Military Natural History Study Cohort: complications and risk factors. J Cataract Refract Surg. 2019;45:1612–1618. Relevant disclosures Legault: None "I think that HIV-positive patients are relatively safe to have refractive surgery and shouldn't be automatically disqualified. However, you need to work with your infectious disease specialists to ensure that the CD4 count is adequate and the viral load isn't too high." —Gary Legault, MD

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