Pre-LASIK Evaluation of Highly Myopic Eyes Can Predict post-LASIK Vitreoretinal Complications (breaks, retinal detachment)

Laser assisted in situ keratomileusis (LASIK) is painless surgery, but it has few complications. These few complications include vitreoretinal complications and anterior segment complications.

A survey was conducted regarding the tertiary care of vitreoretinal complications after LASIK, by worldwide surgeons covering a period of 12 years(1980 to 2002). The surveyed forms were mailed to the surgeons, regarding the experience with treatment for eyes with retinal lesions after LASIK. Total 1252 survey forms were mailed to the worldwide membership of the retina, macula, and vitreous societies. 424 surgeons responded. According to them 31(8.7%) reported tertiary care of patients with post-LASIK retinal breaks and retinal detachments (RD) referred by anterior segment surgeons.

While, 94 eyes in 77 patients, developed post-LASIK vitreoretinal complications (retinal breaks with or without retinal detachment). Seventeen of those total eyes (25.4%) had pre-LASIK vitreoretinal pathology: lattice degeneration (10 eyes), lattice degeneration and breaks (six eyes), and breaks only (one eye).

The focus of the scientists were on these 17 patients, ranged form 22 to 63. Their mean of myopia was 11.0 deoptres (D), and the range of myopia was between -3.5 to -17D. The mean time of interval from LASIK to retinal lesions was 8.8 months, and their mean follow up time was 9.6 months.

Fourteen of 17 eyes (82.3%) developed retinal lesions within 12 months, two eyes within 24 months, and one eye within 36 months after LASIK. 8 eyes showed vitreoretinal complication, 4 eyes showed symptom of flashes, 2 eyes showed symptom of floaters and 2 showed symptoms of both flashes and floaters and one backed off due to personal reasons.

Post LASIK retinal treatment was successful in all the treated eyes. In 10 eyes laser was done, scleral buckling was done on 3 eyes, vitrectomy was done on 1 eye, scleral buckling and vitrectomy was done on one eye, pneumatic retinopexy, scleral buckling, vitrectomy, and silicone oil was done on one eye.

Concluding that, vitreoretinal pathology (lattice degeneration, retinal breaks) before LASIK never guarantees the prevention of post LASIK vitreoretinal complications in highly myopic eyes. As demonstrated by the 10 eyes that developed post-LASIK retinal lesions in spite of pre-LASIK prophylactic retinal treatment. Thus, one cannot assume that pre LASIK prophylactic retinal examination and treatment automatically prevent post-LASIK vitreoretinal complications.

However, it not yet known whether eyes with less myopia would have a lower risk for vitreoretinal complications or not. More study is required to answer such questions.

Source: British Journal of Opthalmology, "Relation of pre-LASIK and post-LASIK retinal lesions and retinal examination for LASIK eyes"

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