It is possible to conduct successful corrective vision surgeries in patients with alpha-1 antitrypsin deficiency (AATD), according to a new study published in the Journal of Clinical Medicine.

However, the lack of defined guidelines for patients with AATD makes it difficult to determine whether procedures such as laser-assisted in situ keratomileuses, photorefractive keratectomy, or small incision lenticule extraction are safe in these patients.

Ocular symptoms are common in patients with AATD. However, the rates of corneal erosions and ulcerations and the risks of descemetoceles and other ocular complications limit the safety and feasibility of corneal refractive surgery in these patients.

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Here, a team of researchers led by Phillip C. Hoopes, MD, from the Hoopes Vision Research Center in Draper, Utah reported on 5 patients with AATD who were successfully treated with laser-assisted in situ keratomileuses. The vision of all 5 patients was corrected with the surgery. Three of the patients had no further complications, while 2 had minor issues after the operation. 

Read more about the symptoms of AATD

“When evaluating patients with AATD for corrective vision surgeries, specific considerations should be taken,” first author Majid Moshirfar, MD, and the coauthors of the study wrote. They also provided a list of suggested questions and tests that can help healthcare professionals evaluate patients for corneal refraction surgery.

These include questions about the patient’s medical history, symptoms, and medications, as well as visual assessment tests, ocular surface integrity tests, and imaging tests like optical coherence tomography, placido corneal topography, and fluorescein angiography.

The authors also stressed the importance of counseling patients with AATD on the potential outcomes of corrective vision surgeries such as dry eye syndrome and the risk of developing corneal erosions and ulcerations. “Patients should be counseled on the risks and benefits of refractive surgery, including suboptimal surgical outcomes,” they wrote, “especially given their history.”


Moshirfar M, Kelkar N, Ronquillo YC, Hoopes PC. Assessing patients with alpha-1 antitrypsin deficiency for corneal refractive surgery: a review and clinical experience. J Clin Med. 2022;11(14):4175. doi:10.3390/jcm11144175