The clinical outcomes of lamellar keratomileusis in patients with human immunodeficiency virus positivity.

BACKGROUND: Given improved survival, HIV + patients are now more likely to pursue common elective procedures, such as refractive surgery. We sought to assess the safety, efficacy, predictability, and stability of lamellar keratomileusis in patients with HIV. METHODS: A study was conducted with 14 patients (28 eyes) HIV-positive patients at Ineye Hospital of Chengdu University of Traditional Chinese Medicine, who underwent lamellar keratomileusis. They were observed for at least one year. 8 patients (16 eyes) had femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and 6 patients (12 eyes) received small incision lenticule extraction (SMILE). Measurements taken before and after surgery included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, spherical equivalent (SE), intraocular pressure, and any complications. RESULTS: At one year postoperatively, all groups showed significant UDVA improvement (P < 0.001): overall from 1.36 ± 0.18 LogMAR to -0.07 ± 0.07 LogMAR, SMILE from 1.37 ± 0.18 LogMAR to -0.09 ± 0.07 LogMAR, and FS-LASIK from 1.35 ± 0.19 LogMAR to -0.11 ± 0.06 LogMAR, with all patients achieving a UDVA of 20/20 or better. Only 2 eyes (7.14%, both SMILE cases) experienced a 1-line decrease in CDVA. The mean SE improved from − 6.42 ± 1.46 D preoperatively to -0.06 ± 0.04D; with procedure-specific improvements observed: SMILE eyes improved from − 6.00 ± 0.92 D to -0.01 ± 0.26 D, while FS-LASIK eyes improved from − 6.74 ± 1.72 D to -0.09 ± 0.49 D, postoperatively (all P < 0.001). Refractive predictability outcomes revealed 89.29% of eyes within ± 0.50 D (SMILE 100% vs. FS-LASIK 87.50%), 96.43% within ± 1.00 D (SMILE 100% vs. FS-LASIK 93.75%), and 96.00% with astigmatism ≤ 0.50 D (SMILE 100% vs. FS-LASIK 93.75%). During the follow-up, dry eye syndrome occurred in 4 of 14 patients (28.57%, 2 SMILE and 2 FS-LASIK cases), but there were no serious complications, and no healthcare staff contracted HIV. CONCLUSIONS: Laser lamellar corneal refractive surgery in HIV-positive patients demonstrated promising clinical outcomes. It was found to be safe for both healthcare professionals and patients.