Ophthalmology treatments in Turkey: Advanced eye care & vision correction

Risks and Side Effects

Risks depend on the procedure, your eye and your general health. The figures below come from published studies and surveys that differ in methods and definitions: they are indicative, they are not specific to a clinic or to Turkey, and your surgeon must discuss your individual risks with you. Any eye surgery can lead to infection, bleeding, inflammation, a result that differs from the target (for example residual glasses or an under- or over-correction),and, in rare cases, permanent loss of vision. The most serious complications, such as infection inside the eye, retinal detachment, glaucoma and graft failure, can lead to permanent vision loss if they are not treated promptly, which is why follow-up visits and urgent contact with your surgeon matter.

Laser vision correction (LASIK, Femto-LASIK, SMILE)

• Dry eye is the most frequent side effect. In the FDA-sponsored PROWL studies of LASIK, about 23% of patients without dry-eye symptoms before surgery developed mild dry eye at 3 months, and a smaller share (roughly 1% to 5%) developed moderate or severe dry eye. SMILE is associated with less dry eye than LASIK in comparative reviews.
• Glare, halos and starbursts at night, which are most often temporary and are linked to residual refractive error, and an under- or over-correction that may need an enhancement procedure.
• Flap-related complications with LASIK, which are avoided with SMILE, and long-term data on SMILE that are shorter than for LASIK.
• Serious complications that leave lasting poor vision, including a permanent loss of best-corrected vision, are estimated at fewer than 1% of patients. In a systematic review of 19 studies (about 2,200 patients),95.4% of patients were satisfied and about 4.6% were dissatisfied, mainly because of residual refractive error, dry eye or night vision symptoms (Solomon et al., Ophthalmology, 2009).
• Presbyopia (the need for reading glasses with age) is not prevented by laser correction of myopia.

Phakic ICL implants

• Cataract formation was the main complication in a review of ICL implants: 5.2% (136 of 2,592 eyes) (Fernandes et al., Implantable collamer posterior chamber intraocular lenses: a review of potential complications).
• Loss of corneal endothelial cells, reported at 9.9% at 2 years and 3.7% at 4 years in that review, increased eye pressure, glaucoma, lens malposition and night vision disturbances. Corneal decompensation and secondary glaucoma, which are described complications of ICL implants, can lead to lasting loss of vision if they are not treated. An implant may need to be repositioned or removed.

Cataract surgery, intraocular lens implants and YAG capsulotomy

• Clouding of the capsule behind the lens (secondary cataract) is the most common late complication, reported in roughly 20% to 30% of patients within two to five years. It is treated with a brief YAG laser capsulotomy, which can rarely be followed by retinal detachment (1.9% in one institutional study of 104 eyes).
• Rupture of the posterior capsule during surgery, reported in about 0.6% to 1.5% of cases in experienced hands, which may require additional steps and increases other risks.
• Infection inside the eye (endophthalmitis): rare, reported from about 1 in 750 operations in older series to about 1 in 3,000 to 5,000 in more recent data. It is serious: it can lead to permanent loss of vision and, without early and appropriate treatment, to the loss of the eye, and it requires urgent treatment.
• Retinal detachment (a lifetime risk of about 1 in 150 operations, higher in myopic eyes),which can cause permanent loss of vision if it is not repaired promptly, as well as macular swelling, raised eye pressure and a refractive surprise (the need for glasses after surgery).

Glaucoma treatment

• Laser therapy and eye drops: temporary redness, rise in eye pressure or irritation. Glaucoma damage that has already occurred cannot be reversed, and treatment aims to slow its progression: when glaucoma is not controlled, it can lead to permanent loss of vision.
• Trabeculectomy and other glaucoma surgery: eye pressure that is too low, leakage or infection of the drainage bleb, bleeding, cataract and scarring that makes the operation fail and requires further treatment. These complications can reduce vision, and an infection of the bleb can threaten the eye.

Corneal treatments

• Cornea transplant: graft rejection, reported in 18.4% of eyes in one tertiary center (25.0% after penetrating and 13.6% after lamellar keratoplasty),and nearly half of grafts had a postoperative complication in that study. Endophthalmitis is rare (16 cases in 3,968 transplants) and was about 3.5 times more frequent after penetrating than after endothelial keratoplasty. Long-term corticosteroid treatment and regular follow-up are needed. A graft can fail, which can lead to a renewed loss of vision and to a further transplant.
• Keratoconus treatment and keratoprosthesis: infection, corneal haze, persistent discomfort and, for a keratoprosthesis, complications such as extrusion or raised eye pressure, which can lead to lasting vision loss.

Retinal and macular treatments

• Retinal detachment surgery: the retina can detach again and require another operation, cataract can develop or progress after vitrectomy, and eye pressure can rise. A retinal detachment that is not treated promptly can lead to permanent loss of vision, and vision may remain reduced even when the retina is reattached.
• Anti-VEGF injections: eye redness, discomfort, floaters, inflammation, a rise in eye pressure and, rarely, infection inside the eye, which can cause severe and permanent vision loss. They are usually repeated over months or years.
• Diabetic retinopathy laser or injections and retinitis pigmentosa treatment: they aim to slow the disease or limit its complications, and they do not restore lost vision.

Other procedures (strabismus surgery, iris repair, iridectomy, uveitis treatment, ocular implant, eye cancer treatment): the risks depend on the technique and the disease, and include infection, bleeding, double vision or persistent misalignment for strabismus surgery, and a need for further treatment. They must be explained by your surgeon.

Contraindications and situations requiring caution: untreated eye infection or inflammation, unstable vision, a corneal disease or a cornea that is too thin for laser correction, severe dry eye, pregnancy and breastfeeding for elective refractive surgery, autoimmune diseases and uncontrolled diabetes, and unrealistic expectations. Seek urgent medical care for sudden loss of vision, flashes of light or a shower of floaters, a curtain over the vision, severe eye pain or redness after surgery.