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

J Cataract Refract Surg. 2019 Nov;45(11):1612-1618. doi: 10.1016/j.jcrs.2019.06.017. Epub 2019 Oct 1.


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.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Cornea / surgery*
  • Female
  • HIV Infections / complications*
  • HIV*
  • Humans
  • Lasers, Excimer / therapeutic use*
  • Male
  • Middle Aged
  • Military Personnel*
  • Myopia / complications
  • Myopia / surgery*
  • Photorefractive Keratectomy / methods*
  • Prospective Studies
  • Risk Factors
  • United States
  • Visual Acuity