准分子激光原位角膜磨镶术后视网膜脱离

目的：分析LASIK治疗近视术后发生视网膜脱离的临床特征和处理原则。方法：回顾性分析LASIK术后发生视网膜脱离的3只眼（3例患者）。结果：术前平均屈光度（等值球间，下同）为－9．3D（范围－7．37－－11．50D）。LASIK与网脱发生的间隔时间为0．5－26个月（平均11．8个月）。视网膜裂孔类型和数目：1例为马蹄形，1个；1例为锯齿缘断离；1例为小圆形裂孔，3个，裂孔位置；3例均在赤道部前方，3例通过一次手术后即成功复方。结构：具有视网膜病变的高度近视病在LASIK术后易发生视网膜脱离。     

Retinal detachment in myopic eyes after laser in situ keratomileusis

PURPOSE: To analyze the incidence and characteristics of retinal detachment in myopic patients treated by laser-assisted in situ keratomileusis. METHODS: We retrospectively studied the retinal detachments observed in 1,554 consecutive eyes (878 patients) undergoing laser-assisted in situ keratomileusis for the correction of myopia (follow-up, 30.34+/-10.27 months; range, 16 to 54). Mean patient age was 33.09+/-8.6 years (range, 20 to 60). Before treatment with laser-assisted in situ keratomileusis, all patients had a comprehensive examination, and detected lesions predisposing to retinal detachment were treated before performing the laser-assisted in situ keratomileusis procedure. RESULTS: Retinal detachment occurred in four (0.25%) of 1,554 eyes of four (0.45%) of 878 patients. All four patients who developed retinal detachment in one eye were women. Degree of preoperative myopia was -13.52+/-3.38 diopters (range, -8.00 to -27.50). The time interval between refractive surgery and retinal detachment was 11.25+/-8.53 months (range, 2 to 19 months). In all cases retinal detachment was spontaneous. In all eyes the retina was reattached successfully at the first retinal detachment surgery. Mean best-corrected visual acuity after laser-assisted in situ keratomileusis and before retinal detachment development was 20/43 (range, 20/50 to 20/30). After retinal detachment repair, best-corrected visual acuity was 20/45 (range, 20/50 to 20/32). Differences between best-corrected visual acuity before and after reattachment were not statistically significant (P = .21, paired Student t test). A myopic shift was induced in three eyes that had retinal detachment repaired by scleral buckling, from -0.58+/-0.72 diopter (range, +0.25 to -1.00) before retinal detachment and -2.25+/-1.14 diopters (range, -1.00 to -3.25) after retinal detachment surgery (P = .03, paired Student t test). CONCLUSIONS: Laser-assisted in situ keratomileusis for correction of myopia is followed by a low incidence of retinal detachment. Conventional scleral buckling surgery was successful in most cases and did not cause significant changes in the final best-corrected visual acuity. A significant increase in the myopic spherical equivalent was observed after scleral buckling in these patients.     

Retinal detachment after laser in situ keratomileusis in myopic eyes

PURPOSE: To investigate the incidence, characteristics, and surgical management of retinal detachment (RD) after laser in situ keratomileusis (LASIK) surgery in myopia. DESIGN: Retrospective, observational case series. METHODS: We retrospectively reviewed the RDs observed in 18,342 eyes (9,598 patients) that underwent LASIK for the correction of myopia. All patients had no history of corneal diseases, and preoperative examinations, including a thorough fundus examination, were performed. Patients were followed up for a mean of 20 months (range, four to 27 months), and the clinical features of the RD eyes after LASIK were investigated. RESULTS: RD developed in six patients, including two males and four females. The incidence of a RD after LASIK in this study was 0.033%. Mean degree of pre-LASIK myopia in these eyes was -9.33 diopters (D; range, -6.25 to 14.00 D). The mean interval between LASIK and RD development was 9.25 months (range, two to 18 months). All RDs occurred spontaneously and were managed with vitreoretinal surgeries. Retinal reattachment was achieved at the first RD surgery in all six eyes (100%) at a mean follow-up of 9.3 months (range, three to 18 months). CONCLUSIONS: RD after LASIK for correction of myopia is uncommon. This study suggested no cause-and-effect relationship could be proven between RD development and LASIK procedure in myopia. Clinicians should still be aware of retinal pathologic features in patients undergoing LASIK.     

Retinal detachment in myopic eyes after laser in situ keratomileusis

PURPOSE: To report the characteristics and surgical outcomes of rhegmatogenous retinal detachments in myopic eyes after laser in situ keratomileusis (LASIK). METHODS: Clinical charts of patients that developed rhegmatogenous retinal detachment after LASIK were reviewed. Surgery to repair rhegmatogenous retinal detachment was performed in 31 eyes (mean follow-up of 14 months after vitreoretinal surgery). RESULTS: A total of 38,823 eyes underwent surgical correction of myopia from -0.75 to -29.00 D (mean -6.00 D). Thirty-three eyes (27 patients; frequency .08%) developed rhegmatogenous retinal detachment after LASIK; detachments occurred between 12 days and 60 months (mean 16.3 mo) after LASIK. Eyes that developed a rhegmatogenous retinal detachment had a mean -8.75 D before LASIK. Most rhegmatogenous retinal detachment and retinal breaks occurred in the temporal quadrants (71.1%). Final best spectacle-corrected visual acuity (BSCVA) of 20/40 or better was obtained in 38.7% of the 31 eyes (two patients refused surgery). Poor final visual acuity (20/200 or worse) occurred in 22.6% of eyes. Information regarding visual acuity after LASIK and before the development of rhegmatogenous retinal detachment was available in 24 eyes; 45.8% (11/24 eyes) lost two or more lines of visual acuity after vitreo-retinal surgery. Reasons for poor visual acuity included the development of proliferative vitreo-retinopathy (n=5), epiretinal membrane (n=1), chronicity of rhegmatogenous retinal detachment (n=1), new breaks (n=1), displaced corneal flap (n=1), and cataract. CONCLUSIONS: Rhegmatogenous retinal detachment after LASIK for myopia is a serious complication. Final visual acuity may be limited by myopic degeneration, amblyopia, or delayed surgical repair.     

Bilateral serous macular detachment following laser in situ keratomileusis

PURPOSE: To report a case of bilateral serous macular detachment following laser in situ keratomileusis (LASIK). DESIGN: Observational case report. METHODS: A 33-year-old man presented with sudden decrease of vision in both eyes 4 days following uncomplicated LASIK in both eyes for spherical equivalent of +5.00 diopters sph in the right eye and +7.00 diopters sph in the left eye. Detailed history with ocular and systemic examination, fluorescein angiography, and optical coherence tomography were done. Retinal examination had a documentation of retinal pigment epithelium atrophy in the macular region in both eyes pre-LASIK. RESULTS: A diagnosis of central serous chorioretinopathy (CSCR) was made in both eyes, with multifocal alterations in the retinal pigment epithelium and a pocket of serous retinal fluid in the macular region confirmed on OCT. Late venous phase of fluorescein angiogram demonstrated multiple hyperfluorescent foci of leakage, more in the right eye with areas of retinal pigment epithelium staining. CONCLUSIONS: Preexisting macular pathology, such as retinal pigment epithelium atrophy could be a new contraindication to LASIK for hypermetropia with possible development of CSCR, requiring a careful examination of the fundus pre-LASIK.     

Acute rhegmatogenous retinal detachment immediately following laser in situ keratomileusis

We report a case of acute rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) surgery in a highly myopic patient. Fourteen hours postoperatively, the uncorrected visual acuity was counting fingers in the left eye. Slitlamp examination revealed significant anterior chamber reaction with fibrin-like material. Fundus examination revealed 2 inferior retinal horseshoe tears associated with an RD. Preoperative fundus examination with scleral depression may detect predisposing retinal lesions in highly myopic patients. Further study is required to evaluate the relationship between LASIK, acute postoperative RRD, and predisposing factors.     

准分子激光原位角膜磨镶术后玻璃体后脱离的临床观察

目的评估准分子激光原位角膜磨镶术(laser in situ keratomi leusis,LASIK)后的玻璃体后脱离(posterior vit-reous detachment,PVD)发生情况。方法对43例(85眼)在我院行LASIK矫治近视的近视患者采用眼部B超检查,观察其术前与术后第3天、第1、第3、第6个月的PVD发生情况。结果本组患者术前PVD发生率为11.8%;术后6个月随访中共有21眼(21/75,28%)新发生PVD,差异有非常显著性(P<0.01);Logistic回归分析显示眼轴较长是术后发生PVD的高危因素;未观察到视网膜裂孔、视网膜脱离等严重眼后段并发症。结论LASIK可诱发PVD,眼轴较长者更易发生。术后6个月随访中未观察到严重眼后段并发症。     

Early rhegmatogenous retinal detachment following laser in situ keratomileusis for high myopia

PURPOSE: Four eyes had early rhegmatogenous retinal detachment within 3 months of laser in situ keratomileusis (LASIK) for correction of high myopia using the microkeratome, Clear Corneal Molder. METHODS: In two eyes, retinal detachment resulted from horseshoe tears, one occurring in an otherwise normal region of the retina and the other at the margin of an area of lattice degeneration detected during preoperative examination. The first eye was treated with retinopexy using a 287 encircling scleral exoplant, drainage of subretinal fluid, and laser photocoagulation by indirect ophthalmoscopy. The other eye was treated with pneumatic retinopexy and cryotherapy. In the other eyes, retinal detachment was the result of giant tears with no evidence of prior retinal degeneration. These eyes were treated with pars plana vitrectomy, fluid-gas exchange with 15% perfluoropropane (C3F8), endolaser photocoagulation, and a 42 encircling scleral exoplant. RESULTS: After treatment, the first two eyes achieved spectacle-corrected visual acuity of 20/40. In the last two eyes, final spectacle-corrected visual acuity was 20/400 in one eye and light perception in the other. CONCLUSIONS: Although no cause-effect relationship between LASIK and retinal detachment can be stated, these cases suggest that LASIK may be associated with retinal detachment, particularly in highly myopic eyes. Further studies are necessary to determine high-risk patient characteristics.     

Retinal detachment following excimer laser

AIMS—To report the clinical presentation, surgical management, and outcome of retinal detachment following excimer laser.
METHODS—Retrospective analysis of retinal detachments observed in 11 eyes of 10 myopic patients who had previously undergone photorefractive keratectomy (PRK) or phototherapeutic keratectomy (PTK) by excimer laser.
RESULTS—Symptoms of visual loss in two eyes were initially attributed to corneal haze. In 10 of 11 eyes visualisation of the retinal detachment and causative break was possible despite mild corneal haze and optical aberrations caused by the refractive laser procedure. Retinal reattachment was achieved in all 11 eyes though one eye required four surgical interventions.
CONCLUSION—This is the first published report to describe an association between retinal detachment and previous excimer laser treatment. The association would appear to reflect the predisposition of myopes to retinal detachment. Clinicians should be aware of potential retinal pathology in patients undergoing PRK.

     

Bilateral retinal detachment after laser in situ keratomileusis

BACKGROUND: We report a case of bilateral retinal detachment after laser in situ keratomileusis(LASIK). CASE: A 49-year-old man received multiple laser photocoagulation for retinal lattice degeneration in both eyes and retinal tears in the left eye. He underwent bilateral LASIK in another country about 6 months after the laser photocoagulation. After the LASIK his eyes showed bilateral retinal detachment, 2 weeks later in the right eye and 5 months later in the left eye. We had to perform retinal detachment surgery four times, scleral buckling, vitrectomy, silicone oil tamponade, and removal of the silicone oil for the right eye, and one scleral buckling procedure for the left eye to achieve retinal attachment. Soon after each retinal surgery, we recognized diffuse flap edema and interface haze, three times in the right cornea and one time in the left, although this corneal flap edema subsided without any sequel. CONCLUSION: In this case, laser photocoagulation had been done several times to prevent retinal detachment in both eyes. However, retinal detachment occurred 2 weeks after LASIK in the right eye, and therefore, the LASIK procedure was considered to be the main factor influencing the development of the retinal detachment. The left eye showed retinal detachment 5 months after LASIK and we thought it possible that this retinal detachment occurred as a natural consequence of myopia. We believe it is important to hava a thorough funduscopic examination done before LASIK and it is necessary to pay attention to corneal edema and interface haze after retinal detachment surgery for post-LASIK patients.     

Retinal detachment following neodymium-YAG laser capsulotomy

Five patients developed retinal detachments within one month of undergoing neodymium-YAG laser posterior capsulotomy. In four patients rhegmatogenous retinal detachments developed in association with typical aphakic breaks; in the fifth patient a previously stable extramacular traction detachment extended into the fovea. In all five patients scleral buckling or vitrectomy successfully reattached the retina and visual acuity improved. None of the findings associated with the detachments could be definitely attributed to the YAG laser. These included the lack of structural or positional changes in the vitreous as well as the absence of retinal damage. We were unable to learn the specific settings used for each laser but were told that the minimum energy levels needed to produce a capsulotomy were used.     

LASIK术后视网膜脱离的治疗

目的 探讨Lasik术后视网膜脱离及其治疗的特点。方法 分析了10例11只眼Lasik术后视网膜脱离的患者的特点、手术方式、术后并发症等。结果 11只眼中,周边多发性视网膜裂孔8只眼（72.73%）,巨大裂孔3只眼（27.27%）。所有患者均行环扎术,其中3例行玻璃体切割术和硅油填充术。1例术后出现角膜瓣翻转,1例术后出现了角膜瓣下混浊。结论 Lasik术后的视网膜脱离,以周边多发性视网膜裂孔多见,巨大裂孔发生率高;手术方式首选巩膜扣带术。在诊治中要注意保护角膜,避免出现角膜的并发症。Lasik术后复查应常规散瞳检查眼底。高度近视患者要慎行Lasik术。     

Peripheral keratitis following laser in situ keratomileusis

PURPOSE: To report two different cases of sterile, peripheral keratitis following laser in situ keratomileusis (LASIK). METHODS: A report of two cases (two eyes of two patients). RESULTS: In two patients, peripheral infiltrates appeared 1 day after LASIK. One patient had a history of rheumatoid arthritis and both had peripheral corneal changes that may have represented prior inflammatory events. The presentations were quite different, with one occurring in association with an epithelial defect at the edge of the flap and the other occurring without an epithelial defect peripheral to the microkeratome cut. In the second case a similar infiltrate showed up in the unoperated fellow eye. Both patients were treated with aggressive antibiotic and corticosteroid therapy. Both patients recovered well with no loss of best spectacle-corrected visual acuity. CONCLUSION: Peripheral keratitis can occur in patients following LASIK; preoperative evidence of previous inflammation may be a marker for patients at higher risk. Rheumatoid arthritis patients may be at increased risk for this complication. With careful and aggressive management excellent visual outcomes are still possible.