Floaters and Retinal Damage after LASIK

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.

Patients who experience floaters, retinal problems, or other complications after LASIK should file a MedWatch report with the FDA online. Alternatively, you may call FDA at 1-800-FDA-1088 to report by telephone, download the paper form and either fax it to 1-800-FDA-0178 or mail it to the address shown at the bottom of page 3, or download the MedWatcher Mobile App for reporting LASIK problems to the FDA using a smart phone or tablet. Read a sample of LASIK injury reports currently on file with the FDA.

Patients with LASIK complications are invited to join the discussion on FaceBook

YouTube video: Patient shares his story of floaters after LASIK

Vision loss within 48 hours of uneventful LASIK due to central retinal artery occlusion - 8/10/2018

Francis et al. CENTRAL RETINAL ARTERY OCCLUSION WITH CILIORETINAL ARTERY SPARING AFTER LASER-ASSISTED IN SITU KERATOMILEUSIS. Retin Cases Brief Rep. 2018 Aug 10. doi: 10.1097/ICB.0000000000000809.

Abstract
PURPOSE: To report a central retinal artery occlusion with cilioretinal artery sparing in a 48-year-old woman after laser-assisted in situ keratomileusis surgery. METHODS: Case history and clinical examination including best-corrected visual acuity, serum markers, slit-lamp biomicroscopy, indirect ophthalmoscopy, fundus photography, fluorescein angiography, and optical coherence tomography. RESULTS: A 48-year-old woman underwent routine laser-assisted in situ keratomileusis surgery in both eyes. On postoperative Day 1, vision was 20/20 in both eyes with full visual fields by confrontation. Eight hours after being examined, she reported photopsias and a new visual field defect in the right eye . Visual acuity was 20/40, pinhole 20/20 in the right eye, with restriction of visual field by confrontation. Dilated fundus examination revealed retinal whitening in all quadrants with sparing of the fovea along the distribution of a perfused cilioretinal artery. Optical coherence tomography showed an intact foveal depression with inner retinal layer hyperreflectivity outside the region of the perfused cilioretinal artery. Fluorescein angiography revealed sectoral nonperfusion of the posterior pole with macular sparing along the patent cilioretinal artery. Hypercoagulable workup, carotid imaging, and magnetic resonance imaging of the brain were unremarkable. CONCLUSION: This is the first report of a central retinal artery occlusion with cilioretinal artery sparing occurring on postoperative Day 1 after laser-assisted in situ keratomileusis surgery.

Study finds up to 85% posterior vitreous detachment (floaters) after LASIK - 7/13/2017

Osman MH, Khalil NM, El-Agha MS. Incidence of Posterior Vitreous Detachment After Femtosecond LASIK Compared With Microkeratome LASIK. Cornea. 2017 Jul 13.

PURPOSE: To compare the incidence of posterior vitreous detachment (PVD) after femtosecond and microkeratome laser in situ keratomileusis (LASIK).

SETTING: Rowad Correction Centre, Cairo, Egypt (a private center affiliated to Cairo University).

DESIGN: Prospective, nonrandomized comparative unmasked study.

METHODS: The study was conducted at a single laser center. Eligible patients chose between femtosecond and microkeratome LASIK after appropriate counseling. B-scan ultrasonography was performed before surgery by a single operator. Patients with preexisting PVD (partial or complete) were excluded. The axial length was also recorded. All surgery was performed by a single surgeon. During surgery, the suction time was measured. Ultrasonography was repeated 1 month after surgery by the same operator to detect PVD.

RESULTS: Ten patients (20 eyes, group M) underwent LASIK using the Moria M2 microkeratome, and 10 patients (20 eyes, group F) underwent femtosecond LASIK with the IntraLase FS-150. In groups M and F, respectively, the proportion of women was 80% and 70%, and the mean age was 24.7 ± 4 years and 25.7 ± 3.3 years, the mean axial length was 24.2 ± 1.2 and 23.8 ± 1.2 mm, and the mean suction time was 18 ± 2 seconds and 63 ± 4 seconds (P < 0.001). After surgery, PVD was detected in 4 eyes (20%) in group M and 17 eyes (85%) in group F (P = 0.000044).

CONCLUSIONS: The incidence of PVD 1 month after femtosecond LASIK was higher than after microkeratome LASIK. This may be due to longer suction time during femtosecond LASIK despite lower suction pressure.

Posterior vitreous detachment 10 years after Lasik reported to the FDA - 11/11/2016

On [redacted by FDA] 2016, I experienced a cloud over my right eye vision, appearance of significant volume and size of floaters, and rapid flashing lights. I went to the ER of a local eye hospital immediately the next morning on the advice of my eye doctor. I was diagnosed with posterior vitreous detachment (PVD) in the right eye. I had lasik surgery in 2005 and experienced occasional floaters over the past 10 years. I have been researching the link between Lasik surgery and retinal/vitreous issues that may be related to weakening of these eye structure as a side effect of Lasik. I am only [redacted by FDA] and in excellent health.

Link to source

Patient with retinal detachment after LASIK calls FDA to report injury - 8/1/2014

Caller reports he had LASIK surgery performed in his right eye in [redacted by FDA] of 2014. Two days after the procedure he reports that his vision started to become distorted and darker. Caller states he went to the doctor and found that his retina was detached and an emergency surgery was performed on [redacted by FDA] 2014. Caller reports that he is still experiencing vision issues.

Link to source

LASIK patient files injury report with FDA, floaters in both eyes

In (b)(6) 2008, i had lasik. Two years later, i had a posterior vitreous detachment in the left eye and now six years later, i have had a posterior vitreous detachment in the right eye. I have very large black floaters in both eyes and a haze or cloudy area in both eyes that make it impossible to focus clearly. Glasses will not correct this because the cloudiness is in my vitreous. I was myopic presurgery with both eyes being about a -6 dpt. Nobody advised me that this could be a side effect. I now feel like i am partially blind. I've also been on restasis for six years and have just switched to a autologous serum eyedrops for my dry eye. The eyedrops have improved the health of my cornea but it does not help with the posterior vitreous detachment. If only i had a time machine to go back and not choose this surgery. Why wasn't i told this could be a risk. Now i worry in the next few years what the next surprise will be from this nightmare of a surgery called lasik. I don't understand why it is legal. Link to source

Patient report floaters and light flashes to FDA, LASIK surgeon tells patient he/she is getting old

Sudden large eye floaters and severe light flashes in right eye. Doctor claimed I am getting old. But I had lasik six years ago, and did not have any problems until now. Link to source

Effect of floaters on quality of life - July 2011

Am J Ophthalmol. 2011 Jul;152(1):60-65.e1. Epub 2011 May 12.
Utility values associated with vitreous floaters.
Wagle AM, Lim WY, Yap TP, Neelam K, Au Eong KG.

Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore; Department of Ophthalmology and Visual Sciences, Alexandra Hospital, Singapore; Eye Clinic, Jurong Medical Center, Singapore; Faculty of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

PURPOSE: To ascertain the health-related quality of life associated with symptomatic degenerative vitreous floaters.

DESIGN: Cross-sectional questionnaire survey.

METHODS: In this institution-based study, 311 outpatients aged 21 years and older who presented with symptoms of floaters were enrolled. Data from 266 patients (85.5%) who completed the questionnaire were analyzed. Utility values were assessed using a standardized utility value questionnaire. The time trade-off (TTO) and standard gamble (SG) for death and blindness techniques were used to calculate the utility values. Descriptive, univariate, and multivariate analyses were performed using Stata Release 6.0.

RESULTS: The mean age of the study population was 52.9 ± 12.02 years (range, 21-97). The mean utility values were 0.89, 0.89, and 0.93 for TTO, SG (death), and SG (blindness), respectively. Patients aged ≤55 years reported significantly lower SG (blindness) utility values when compared with patients above 55 years of age (age ≤55 = 0.92, age >55 = 0.94, P = .007). Utility measurements did not demonstrate significant relationship with any of the other socio-demographic variables examined in this study. The utility values did not demonstrate any significant relationship with other ocular characteristics such as duration of symptoms, presence of a posterior vitreous detachment, and presence or severity of myopia.

CONCLUSIONS: Symptomatic degenerative vitreous floaters have a negative impact on health-related quality of life. Younger symptomatic patients are more likely to take a risk of blindness to get rid of the floaters than older patients.

Corneal refractive surgery affects the vitreoretinal interface - OSN SuperSite 6/2/2011

Excerpt: Corneal refractive surgery causes a mild concussive injury to the eye that affects the vitreoretinal interface, according to a speaker at the Euretina meeting here. "In the most common refractive procedure, that's LASIK, it is the suction ring to destabilize the eye, and in this respect there is no difference between using a keratome or a femtosecond laser," Shalesh Kaushal, MD, said. Link to source

LASIK patient reports floaters, flashes, and retinal tear to the FDA; falsely told not related to LASIK

I had LASIK surgery on [redacted by FDA] 2012. Vision improved to 20/20. I went for my six week post surgery check-up on [redacted by FDA] 2012 and notified the clinic that I had seen floaters for the first time on the Friday before. On that Wednesday morning, I experienced white flashes as well as many floaters. I was then refered to a retinal specialist that afternoon. The retinal doctor found a tear or hole in the retina and performed surgery that same day to repair the damage. I am 5 days post surgery, still good vision. I was very myopic, -7 and was told that the retinas are thinner on people like me and are more prone to tears and that my episode was not related to the LASIK surgery. Source

LASIK patient reports floaters and retinal detachment to the FDA

I had LASIK on my right eye and soon after developed large floaters. In addition, I have had five retinal detachments in the eye and may end up legally blind in the eye. LASIK on right eye in 2000. Source

LASIK patient reports detached retina to the FDA

I had LASIK surgery in 2001. I had extremely poor vision and was near sighted prior to the surgery. This year [2011] I lost nearly all of my sight due to a detached retina and macular pucker. I got my sight back after surgery. I have spoken to several people and they have told me that they know of several cases where someone has had the same problem and even lost their sight completely in one eye some time after having LASIK surgery. I have asked my ophthalmologist and others involved in treating my condition and they all said emphatically that there is no connection between the two. I found on the web that it can be one of the outcomes in a small amount of cases. First, since it does not seem to be tracked and is not even acknowledged by many professionals it may be more prevalent than known and either way we should at least be warned of this possible complication. This was LASIK surgery that I believed caused my detached retina. Source

Patient reports multiple problems after LASIK to the FDA

I had LASIK in [redacted] 2011, I was having flashing lights in my right field of vision and went to the ER and then to eye specialist and was diagnosed with posterior vitreous detachment. I am now having other problems in my right eye reduced vision, swollen optic nerve, and irregular color vision between two eyes, and possible epiretina membrane. I am waiting for more test results to come back. I do believe I maybe having these issues due to having LASIK. Source

Patient reports floaters after LASIK to the FDA

I have tried this before. I had LASIK done and I reported 3 times that I had floaters in my left. On the 3rd time, I was told I had to live with them. Why was I not told about this condition? there is nothing in my file about this problem which I am talking about. I bought an insurance warranty. I have requested the [redacted by FDA] returned but they have refused to return my money. I am [redacted by FDA] and cannot afford to go see an eye doctor. I have other problems as crystals in that eye and must use eye drops also or my eye burns. There is paper work in my file I never saw before. I have tried to call your place several times, but I get blown off by your operators being rude to a person with a hearing problem. And I do mean rude, ask a girl named [redacted by FDA] how rude she was; oh I am sure you will look her up. [redacted by FDA]. Source

Patient letter to an eye doctor seeking help for floaters after LASIK

I am thirty years old, and I underwent the Lasik procedure back in late September of 2008. My left eye healed very fast, and today I have excellent vision in it without any problems. However, while my right eye improved, I am still nearsighted in it. That is, I have trouble reading a street sign more than fifteen feet away. But my main problem is that I now have several floaters in my right eye. Read letter

LASIK Patient Reports Multiple Complications, Including Floaters, to the FDA

I observed my first floaters--signs of a posterior vitreous detachment--within weeks of the LASIK surgery - reported September 2001. This I have learned is due to the high pressure caused by the suction ring used with the microkeratome, which your agency has approved for medically unnecessary purposes. Read more

Patient Files Report With the FDA of Severe Floaters After LASIK

Bad lasik. Unlike many others, i read everything my doctor gave me and much on the web. I was ready for the halos and starburst, but hopeful that they would not occur. Not only did i get the halos and starburst, but i also had two others, and one far worse problem that was never disclosed to me by my doctor. Lasik also can cause your near vision to become worse. Immediately after the surgery i needed my reading glasses. When i asked my doctor, he indicated, "oh yes, that sometimes happens" and explained the reason why. Would have been nice to know before the surgery. Far worse was a severe increase in floaters in one eye again never reported. It is so bad that i literally cannot see out of that eye at certain times, and even in the best of cases, it's like someone put a piece of wax paper in front of that eye. My surgeon was widely known and highly regarded even appearing on abc's 20/20 as a fixit of other peoples problems, and he turned out to be a charlatan. Dates of use: 2002. Diagnosis or reason for use: see better. Source

LASIK Patient Reports Poor Vision, Photophobia, and Floaters to the FDA

Lasik, prk eye surgery left eye prk, right eye lasik. Extreme difference from l to r eye. Left eye also still has bad astigmatism, had to get prescription reading glasses for one eye to slow down headaches. I paid the extra per eye, for lifetime touch up. After waiting 1 yr, i went back to see if they could balance out the eye better and was told no. Unless they get worse than 20/40 they would not do it. That was not told to me at the time of surgery. Why pay the extra money then? i am now very light sensitive. As my md told me, photo-phobic. The need for sunglasses is all the time and i have even had a few episodes that were so severe that i had to pull over when driving. It is interfering with my work. Floaters or what i would term as dirt floating around in the eyes, which is really loose blood vessels. I was told that these would go away after a few weeks as they started shortly after the surgery. It's been a year and a half and there's still a lot of them. Source

A Patient's Letter to the FDA, Post-LASIK Floaters

"I am now suffering from an all too common list of "complications", ghost images from both eyes in all lighting conditions, starbursts, halos, dry eyes, and floaters. If I were forced to choose which was the most troublesome, I would say the floaters. I have a desk job, and looking at the computer screen all day is just torture." Read letter

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

Patient letter to LasikComplications.com, Retinal detachment after LASIK

I had Lasik in Oct. 1999. I was quite traumatized by the procedure, even though it appeared to go well. I spent the rest of the week in bed and could not sleep for 2 nights. In Nov. 2000, I suffered a detached retina. My eye had a reaction to the scleral buckle and I have big marks in my eye. I did see a doctor about removing the marks, but didn't do anything. One mark went away by itself. I now have problems with dry eye. My former severely nearsighted right eye has never been the same since Lasik. The left eye is fine, and I still read the 20/20 line. Nothing was worth the detachment, or the suffering and worry since Lasik. I went to a highly recommended doctor and I am a very good patient. I would like to see a lot more info about the Lasik complciations, esp the chances of a detachment--the worst thing that ever happened to me. Thank you. GG

During the application of suction [during LASIK], the blood circulation in the retina and choroid stop - but the duration is very short, he said. "After the removal of the suction, because of the stoppage of the blood flow, initially there will be a need for more oxygen in the retina and choroidal tissue," Peyman said. "Therefore, a big compensation occurs in the form of hyperemia of these tissues."

Source: Getting in tune with ocular blood flow, EyeWorld, December 2000

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:

J Cataract Refract Surg. 2011 Apr;37(4):778-80.
Bilateral central serous retinopathy following laser in situ keratomileusis for myopia.
Peponis VG, Chalkiadakis SE, Nikas SD, Makris NK, Ladas ID, Karagiannis DA.

Abstract

We describe the case of a 54-year-old white man who experienced bilateral central serous chorioretinopathy following laser in situ keratomileusis for myopia. Postoperatively, the uncorrected visual acuity was 20/20 in both eyes. One month later, the patient reported a decrease of vision in both eyes. Dilated fundus examination, fluorescein and indocyanine green angiography, and optical coherence tomography showed bilateral central serous chorioretinopathy. Photodynamic therapy was performed twice, and visual acuity improved.

J Cataract Refract Surg. 2011 May 4. [Epub ahead of print]
Occurrence of posterior vitreous detachment after femtosecond laser in situ keratomileusis: Ultrasound evaluation.
Gavrilov JC, Gaujoux T, Sellam M, Laroche L, Borderie V.

Abstract
PURPOSE: To analyze the modifications to the vitreous body after femtosecond laser-assisted laser in situ keratomileusis (LASIK) for myopia.

SETTING: Centre Hospitalier National Des Quinze-Vingts, Paris, France.

DESIGN: Case series.

METHODS: B-scan ultrasonography of the posterior ocular segment was performed the day before and 48 hours after femtosecond LASIK for myopia. Posterior vitreous detachment (PVD) was diagnosed by the presence of a low-reflected mobile echogenic membrane partially or completely detached from the retina. Eyes with signs of partial or total PVD on preoperative examination were excluded. Occurrence of total or partial PVD after surgery was the main outcome measure.

RESULTS: Thirty-one eyes of 18 patients (10 women; mean age 28 years ± 5 [SD]) were included in the study. The mean preoperative spherical equivalent was -4.38 diopters (D) (range -2.88 to -6.75 D). After surgery, 5 eyes (16%) developed partial or total PVD. The remaining 26 eyes had no signs of PVD postoperatively.

CONCLUSION: Although less vacuum is required to create a corneal flap with a femtosecond laser than with a conventional microkeratome, the incidence of PVD after femtosecond laser-assisted LASIK was similar to that reported for microkeratome-assisted LASIK.

Ophthalmic Surg Lasers Imaging. 2009 Mar-Apr;40(2):180-4.
Bilateral retinal detachment after laser in situ keratomileusis.
Al-Rashaed S, Abboud E, Al-Dhibi H.
Vitreoretinal Division, King Khaled Eye Specialist Hospital, Al-Arouba, Riyadh, Saudi Arabia.

A 37-year-old man developed retinal detachment after laser in situ keratomileusis (LASIK) in both eyes. Causes for the retinal breaks were a horseshoe tear and a giant tear. Both eyes were treated by vitrectomy and scleral buckle. Four months later, the patient developed a recurrent detachment in the right eye with cataract that was managed surgically. Both retinas were flat after a 20-month follow-up period. Bilateral rhegmatogenous retinal detachment after LASIK for correction of myopia can be a serious complication. Patients should be informed about the possibility of this complication. Previous reports of retinal detachments after LASIK and possible related mechanisms were also reviewed.

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.