LASIK creates several types of ocular mechanical stress: (a) an increase in intraocular pressure (> 65 mm Hg.) during suction, (b) an acoustic shock wave during laser ablation, and (c) a rapid lowering of intraocular pressure when the suction ring is decompressed. These mechanical stressors have the potential to damage the vitreous, retina, and macula. Many patients report increased floaters (posterior vitreous detachment) after LASIK.
Patient Reports Post-LASIK Floaters to FDA
"I had custom intralase lasik in 2007. My vision in my left eye was 20/40 after surgery. I had an enhancement done in seven months later on my left eye. Several weeks after enhancement, i noticed floaters in both eyes but especially in my left eye. These have not improved in the 6 months or so after my enhancement. These floaters consume most of my waking thoughts. I have researched for hours to find out there is nothing that can be done about them. They have caused me enormous stress and depression. I have a hard time with the thought that i will have to live with these forever. When i had the surgery, there was never any mention of floaters in the papers that i signed. I realize i took a risk having surgery, but is it possible that a study could be done to determine if floaters are indeed caused by lasik? there are so many people that have floaters that are struggling to cope with this garbage in their eyes. I know it is not a life threatening condition but i know that quality of life is definitely diminished. Please take this seriously. I would go back to my glasses days in a heartbeat ! !." Source
Patient Reports Post-LASIK Retinal Detachment to FDA
"Received lasik eye surgery on my right eye. Prior to my appointment i had many scans from the tlc ctr on my right eye. I had all the required pre-op appointments. The day of my surgery, the doctor put the ring around my eye. The device was off ctr and had to be adjusted and put back on. My eye ball swelled and i had a large red ring where the device was. The lasik was performed. Outcome was good. Two months later, i awoke to great pain in my right eye. Later that morning, i noticed that i was missing vision from the ctr of my eye up. I was like someone pulled a shade over half my eye. I went to the eye doctor for my follow up visit, and i mentioned this new development. My retina detached. I had to see a specialist for a scleral buckle. This reattached my retina. However, i no longer have 20/20 vision in my right eye. I was told they can reperform the lasik to recorrect my vision. After all that, i went through i do not think i will have it redone. I have since gone into a deep depression and now i am being treated for that. I still have to see the retinal specialist for check up. I have very poor night vision in my right eye. In the paper work, i signed for the surgery for lasik procedure it did say that there was a possibility of detached retina, however, i did not understand what that meant." Source
High-pressure vacuum during LASIK by Matt Young, EyeWorld Contributing Editor
EyeWorld, December 2007
From the article:
“We have illustrated the changes to be more complex than previously reported as the anterior and posterior structures respond differently to high vacuum, making the axial length measurement less illuminating,” Dr. Davis reported. “Although the clinical significance has yet to be determined, biomechanical deformation by a rapid sequence of compression and decompression associated with LASIK theoretically may increase the risk of vitreoretinal pathology.”
LASIK unquestionably has become a popular procedure, in no small part due to its safety and efficacy. But for Dr. Davis, questions still remain about retinal detachment. Dr. Davis noted the yearly incidence of phakic idiopathic rhegmatogenous retinal detachment is only 6.1 to 9.1 per 100,000 people (or 0.0061 to 0.0091%). That’s for all refractive errors.
But, he noted, in one study of 1,554 LASIK eyes with a mean spherical equivalent of –13.52 D, the rate of detachment was 0.25%. In another study of 3,009 LASIK eyes with a mean spherical equivalent of –13.77 D, the rate was 0.36%. Lower risk has been reported with lower myopia but at rates still higher than the general population.
Source: http://www.eyeworld.org/article.php?sid=4164
Read medical studies regarding vitreoretinal damage after LASIK:
Ophthalmology. 2005 Jul;112(7):1207-12.
Full-thickness macular hole after LASIK for the correction of myopia.
Arevalo JF, Mendoza AJ, Velez-Vazquez W, Rodriguez FJ, Rodriguez A, Rosales-Meneses JL, Yepez JB, Ramirez E, Dessouki A, Chan CK, Mittra RA, Ramsay RC, Garcia RA, Ruiz-Moreno JM.
Retina and Vitreous Service, Clinica Oftalmologica Centro Caracas, Caracas, Venezuela. areval1@telcel.net.ve
PURPOSE: To describe 19 patients (20 eyes) who developed a macular hole (MH) after undergoing bilateral LASIK for the correction of myopia.
DESIGN: Noncomparative, interventional, retrospective, multicenter case series.
PARTICIPANTS: Nineteen patients (20 eyes) who developed an MH after bilateral LASIK for the correction of myopia at 10 institutions in Venezuela, Colombia, Puerto Rico, Spain, and the United States.
METHODS: Chart review.
MAIN OUTCOME MEASURE: Macular hole development.
RESULTS: The MH formed between 1 to 83 months after LASIK (mean, 12.1). In 60% of cases, the MH developed < or =6 months after LASIK, and in 30% of cases it developed > or =1 year after LASIK. Eighteen of 19 (94.7%) patients were female. Mean age was 46 years (range, 25-65). All eyes were myopic (range, -0.50 to -19.75 diopters [mean, -8.9]). Posterior vitreous detachment was not present before and was documented after LASIK in 55% of eyes. A vitrectomy closed the MH on the 14 eyes that underwent surgical management, with an improvement of final best-corrected visual acuity in 13 of 14 (92.8%) patients. Our 20 eyes with a full-thickness MH after LASIK reflect an incidence of approximately 0.02% (20/83938).
CONCLUSION: An MH may infrequently develop after LASIK for the correction of myopia. Our study shows that vitreoretinal surgery can be successful in restoring vision for most myopic eyes with an MH after LASIK. Vitreoretinal interface changes may play a role in MH formation after LASIK for the correction of myopia.
Graefes Arch Clin Exp Ophthalmol. 2001 Jul;239(6):416-23.
Vitreoretinal alterations following laser in situ keratomileusis: clinical and experimental studies.
Luna JD, Artal MN, Reviglio VE, Pelizzari M, Diaz H, Juarez CP.
Fundacíon Ver, Córdoba, Argentina
BACKGROUND: The presence of vitreoretinal changes following laser in situ keratomileusis in myopia is evaluated.
METHODS: Clinically, 50 patients (100 eyes) with marked anisometropic myopia, 50 low-myopic eyes (<4.00 D) and 50 high-myopic eyes (>7.00 D) were prospectively evaluated pre- and postoperatively for the presence of newly recognized entoptic phenomena (vitreous floaters, light flashes, or both), and for vitreoretinal changes using indirect depressed fundus examination, a +90 D preset lens, Goldman three-mirror contact lens, and kinetic ultrasound (KU) before and after bilateral LASIK. Patients with previous partial or total posterior vitreous cortex detachment (PVD) were excluded. Experimentally, groups of adult pigs underwent KU, retinal fluorescein angiography (FA), and electroretinography (ERG) before and after applying the microkeratome suction ring for 30 s.
RESULTS: Clinically, 8% (4 eyes) had positive perception of postoperative vitreous floaters in the low myopia group, and 32% (16 eyes) in the high myopia group. Postoperative light flashes were noted only in the high myopia group, in 12% of cases. Partial or total posterior vitreous cortex detachment was detected by biomicroscopy in 2% (1 eye) of the low and in 10% (5 eyes) of the high myopia group and by KU in 4% (2 eyes) of the low and in 24% (12 eyes) of the high myopia group. Experimentally, 2 pig eyes out of 12 developed partial PVD by KU, immediately after microkeratome suction ring application. All pig eyes showed significantly diminished ERG amplitudes during and immediately after suction ring application. No FA changes or delays in retinal circulation time were noted during or immediately after removal of the suction ring.
CONCLUSIONS: Vitreoretinal alterations after LASIK were demonstrated clinically mainly by KU in high myopes. Experimentally, PVD were also demonstrated. Diminished ERG recordings with normal retinal circulation following suction ring application may suggest some transient choroidal circulation abnormalities.
Br J Ophthalmol. 2005 Nov;89(11):1423-6.
Vitreoretinal surgery for macular hole after laser assisted in situ keratomileusis for the correction of myopia.
Arevalo JF, Rodriguez FJ, Rosales-Meneses JL, Dessouki A, Chan CK, Mittra RA, Ruiz-Moreno JM.
Clinica Oftalmologica Centro Caracas, Centro Caracas PH-1, Av Panteon, San Bernardino, Caracas 1010, Venezuela. areval1@telcel.net.ve
AIMS: To describe the characteristics and surgical outcomes of full thickness macular hole surgery after laser assisted in situ keratomileusis (LASIK) for the correction of myopia.
METHODS: 13 patients (14 eyes) who developed a macular hole after bilateral LASIK for the correction of myopia participated in the study.
RESULTS: Macular hole formed 1-83 months after LASIK (mean 13 months). 11 out of 13 (84.6%) patients were female. Mean age was 45.5 years old (25-65). All eyes were myopic (range -0.50 to -19.75 dioptres (D); mean -8.4 D). Posterior vitreous detachment (PVD) was not present before and was documented after LASIK on 42.8% of eyes. Most macular hole were unilateral, stage 4 macular hole, had no yellow deposits on the retinal pigment epithelium, had no associated epiretinal membrane, were centric, and had subretinal fluid. The mean diameter of the hole was 385.3 microm (range 200--750 microm). A vitrectomy closed the macular hole on all eyes with an improvement on final best corrected visual acuity (VA) on 13 out of 14 (92.8%) patients.
CONCLUSIONS: This study shows that vitreoretinal surgery can be successful in restoring vision for most myopic eyes with a macular hole after LASIK.
Graefes Arch Clin Exp Ophthalmol. 2006 Feb;244(2):149-53. Epub 2005 Jul 26.
Incidence of posterior vitreous detachment after laser in situ keratomileusis.
Mirshahi A, Schöpfer D, Gerhardt D, Terzi E, Kasper T, Kohnen T.
Department of Ophthalmology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
BACKGROUND: Vitreoretinal complications are rare in laser in situ keratomileusis (LASIK). Increase in intraocular pressure caused by intraoperative suction with subsequent deforming of the ocular globe and excimer laser shock during the ablation have been discussed as possible causes. The purpose of this study was to determine the effect of LASIK on the vitreous body.
PATIENTS AND METHODS: In a prospective study we performed ocular ultrasonography (B scan) immediately before and 1 week after LASIK procedure in 103 myopic or myopic-astigmatic eyes (53 patients, mean age 36.3 years, 32 women, 21 men). In particular, the prevalence, localization, and extent of posterior vitreous detachment (PVD) were determined.
RESULTS: The mean spherical equivalent was -4.85 D (range -1.25 to -8.38) and the mean anteroposterior ocular globe length was 25.13 mm (range 23.31-27.65). Ninety-five eyes (92.2%) had no PVD preoperatively. Nine eyes out of this group (seven patients, 9.5%) developed incomplete PVD as assessed 1 week postoperatively. Eight eyes (7.8%) had a partial PVD preoperatively and in only one eye was an extension of vitreous detachment observed after the surgery. None of the preoperatively measured parameters could predict the occurrence of PVD by LASIK.
CONCLUSIONS: LASIK may in rare cases lead to new occurrence of PVD or extension of a previously existing partial PVD.
J Refract Surg. 2002 Nov-Dec;18(6):708-14.
Retinal detachment in myopic eyes after laser in situ keratomileusis.
Arevalo JF, Ramirez E, Suarez E, Cortez R, Ramirez G, Yepez JB.
Retina and Vitreous Service, Clinica Oftalmologica Centro Caracas, San Bernardino, Caracas, Venezuela. areval1@telcel.net.ve
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.
Ophthalmology. 2005 Apr;112(4):645-9.
Effect of microkeratome suction during LASIK on ocular structures.
Mirshahi A, Kohnen T.
Department of Ophthalmology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
PURPOSE: To study the effect of microkeratome suction on ocular structures during LASIK. DESIGN: Observational, prospective case series.
PARTICIPANTS: Twenty-one eyes of 11 patients with myopia or astigmatic myopia (8 females, 3 males) were included. The mean patient age was 36.3 years (median, 37 years; range, 24-48 years), and the mean spherical equivalent was -5.03 diopters (D) (median, -4.63 D; range, -2.38 to -8.38 D). METHODS: We performed preoperative and intraoperative A-scan ultrasonography during application of suction using the Hansatome microkeratome (Bausch & Lomb Surgical, Munich, Germany) to create corneal flaps during LASIK. We also performed preoperative and postoperative B-scan ultrasonography of the posterior ocular segment with special attention to the presence and size of posterior vitreous detachment (PVD).
MAIN OUTCOME MEASURES: We measured changes in the axial length, anterior chamber depth, lens thickness, and vitreous distance (distance from the posterior lens capsule to the posterior pole) during application of the microkeratome suction ring and recorded new occurrences of or increases in the size of the PVD after surgery.
RESULTS: The lens thickness decreased (mean change, -0.20 mm; P = 0.001; 95% confidence interval [CI], -0.11 to -0.30) in 18 eyes during application of the suction ring. The vitreous distance increased (mean change, 0.20 mm; P = 0.004; 95% CI, 0.08-0.32) in 16 eyes. No statistically significant changes were found in the anterior chamber depth (P = 0.75) or axial length (P = 0.51). After surgery, 3 of 14 eyes (21.4%) experienced PVD that did not have echographic signs of PVD before surgery. Of 7 eyes with preoperative PVD, the PVD enlarged in 1 eye (14.3%).
CONCLUSIONS: During application of microkeratome suction, the lens thickness decreases, whereas the vitreous distance increases, suggesting anterior traction on the posterior segment. The relationship between the observed PVD and LASIK merits further investigation.
Ophthalmic Surg Lasers Imaging. 2006 Nov-Dec;37(6):486-8.
Valsalva-like retinopathy following hyperopic laser in situ keratomileusis.
Moshfeghi AA, Harrison SA, Reinstein DZ, Ferrone PJ.
Department of Ophthalmology, North Shore University Hospital, Great Neck, New York, USA.
A 50-year-old woman presented with unilateral acute loss of vision 15 hours after undergoing bilateral hyperopic laser in situ keratomileusis (LASIK). She denied "straining." Fluorescein angiography showed no retinal vascular abnormalities but demonstrated blocked fluorescence corresponding with subhyaloid, intraretinal, and subretinal hemorrhages seen clinically in the left eye. YAG laser vitreolysis was performed after noting posterior cortical vitreous thickening with a loculated subhyaloid hemorrhage. Best spectacle-corrected visual acuity was restored to 20/20 by the 2-month follow-up examination. Valsalva-like retinopathy, possibly the result of the rapid rise and fall of intraocular pressure during the microkeratome and suction ring operation, may occur following hyperopic LASIK surgery.
J Cataract Refract Surg. 2004 Jun;30(6):1382-4.
Complete bilateral vitreous detachment after LASIK retreatment.
Smith RJ, Yadarola MB, Pelizzari MF, Luna JD, Juárez CP, Reviglio VE.
Department of Ophthalmology, Fundación VER, Córdoba, Argentina, Argentina.
We describe a case of a 47-year-old woman who underwent bilateral laser in situ keratomileusis (LASIK) for the correction of myopia and astigmatism. Two months later a residual refractive error was present in both eyes. LASIK retreatment was decided and performed the following day. Twenty-four hours after the procedure, the patient reported myodesopsia in both eyes. Funduscopic examination revealed a complete bilateral posterior vitreous detachment confirmed by kinetic ultrasound. Visual disturbance in both eyes continued to be present after 10 months of follow-up. Sudden changes in intraocular pressure related to suction ring use might be the cause of posterior vitreous detachment in this patient.
Related Topic: Maculopathy
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