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

Purpose This study sought to assess the frequency of refractive surgery complications in human immunodeficiency virus-positive (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+ servicemembers 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 acquired immune deficiency syndrome (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, two radial keratotomy (RK), and one astigmatic correction. Complications occurred in 6 (7.6%) of 79 participants, including 5 patients who underwent PRK and one after RK, occurring between 8 and 217 days after surgery. Five ulcers and one 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.