Exposing the LASIK Scam

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 Post subject: LASIK microkeratome suction ring damage
PostPosted: Fri Nov 25, 2005 2:37 pm 
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http://www.ncbi.nlm.nih.gov/entrez/quer ... uery_hl=19

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.


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PostPosted: Mon Jan 16, 2006 3:18 am 
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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, Juarez CP, Reviglio VE.

Department of Ophthalmology, Fundacion VER, Cordoba, 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.

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PostPosted: Sun Jul 01, 2007 1:28 am 
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Ocular Structure Changes During Vacuum by the Hansatome Microkeratome Suction Ring

Journal of Refractive Surgery Vol. 23 No. 6 June 2007
Richard M. Davis, MD; Jason A. Evangelista, MD

PURPOSE
To evaluate whether the vacuum of a microkeratome suction ring induces ocular structure changes.

METHODS
A prospective case series using A-scan ultrasonography to measure anterior chamber depth, lens thickness, vitreous body, and axial length was performed. Measurements before and during application of a Hansatome microkeratome suction ring were performed on 69 eyes of 39 consecutive patients scheduled to undergo a first-time LASIK procedure with mechanical creation of a corneal flap.

RESULTS
Mean patient age was 43?12.1 years. Of the 69 eyes, 63 (91.3%) had refractive myopia with a mean spherical equivalent refraction of ?2.93?1.56 diopters (D) and 6 (8.7%) had refractive hyperopia with a mean spherical equivalent refraction of 1.37?0.31 D. Overall, the mean spherical equivalent refraction of all eyes was ?2.56?1.94 D. Ultrasound measurements during suction revealed a decrease in the anterior chamber depth of ?0.06?0.36 mm (P<.05) and lens thickness by ?0.14?0.45 mm (P<.05) whereas the vitreous body increased 0.25?0.36 mm (P<.05). Although insignificant, a trend toward increasing axial length was noted. No measurements changed over time during the application of vacuum.

CONCLUSIONS
Vacuum by a microkeratome suction ring induced a compression of the anterior chamber and lens with commensurate expansion of the vitreous body. The assessment of vacuum effects during LASIK suggests that measurements of intraocular compartments are more informative than axial length. [J Refract Surg. 2007;23:563-566.]

From the full text:

Quote:
Before the application of the excimer laser in LASIK, vacuum is applied to the external surface of the eye by a suction ring in the form of a microkeratome or a femtosecond laser to assist with the creation of a lamellar corneal fl ap. The vacuum may increase the intraocular pressure (IOP) to >90 mmHg in less than 5 seconds, which could induce vitreoretinal changes.


Quote:
Although the limiting factor of using A-scan ultrasonography for lens thickness and using mathematical formulations to calculate vitreous body measurements are acknowledged, our study has conclusively shown
compression of the anterior structures with elongation of the vitreous body and a trend of increasing axial length (P=.057). 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. 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
.

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PostPosted: Sat Jul 21, 2007 3:36 pm 
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Ocular Structure Changes During Vacuum by the Hansatome Microkeratome Suction Ring

Journal of Refractive Surgery Vol. 23 No. 6 June 2007

Richard M. Davis, MD; Jason A. Evangelista, MD

Quote:
The vacuum may increase the intraocular pressure (IOP) to >90 mmHg in less than 5 seconds, which could induce vitreoretinal changes.


Quote:
After the vacuum from a Hansatome microkeratome suction ring was initiated, a rise in IOP was verified by a Barraquer tonometer (Ocular Instruments Inc, Bellevue, Wash) and by verbal confirmation from the patient that a fixation light had lessened or disappeared.


Quote:
Although the limiting factor of using A-scan ultrasonography for lens thickness and using mathematical formulations to calculate vitreous body measurements are acknowledged, our study has conclusively shown compression of the anterior structures with elongation of the vitreous body and a trend of increasing axial length (P=.057). 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. 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.


Quote:
Axial myopia is the most common risk factor in nontraumatic rhegmatogenous retinal detachment with a refractive error from -1.00 to -3.00 D having a four-fold increased risk and a refractive error >-3.00, a nearly ten-fold increased risk of rhegmatogenous retinal detachment.

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Ann Ophthalmol (Skokie). 2006 Summer;38(2):139-40.
Hemi-retinal vein occlusion following LASIK.
Smith BT, Park CH, Fekrat S.
Barnes Retina Institute, St. Louis, MO, USA. smithbradleythomas@msn.com

We report a case of hemi-retinal vein occlusion following laser-assisted in situ keratomileusis (LASIK) in a healthy 46-year-old Caucasian male. A hemi-retinal vein occlusion following LASIK could be coincidental. However, young age, absence of risk factors and negative laboratory testing require consideration of a causal relationship.

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PostPosted: Thu Feb 14, 2008 3:11 pm 
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Optic Neuropathy After Epi-LASIK

Journal of Refractive Surgery Vol. 24 No. 2 February 2008
Sandra R. Montezuma, MD; Simmons Lessell, MD; Roberto Pineda, MD

PURPOSE
To report a case of optic neuropathy after epi-LASIK.

METHODS
A 24-year-old man developed optic neuropathy after epi-LASIK, possibly related to the barotrauma created by the suction ring. Optic neuropathy and steroid-induced ocular hypertension were diagnosed. Prednisolone drops were discontinued and timolol was started.

RESULTS
After 2 weeks, his symptoms improved and the pain resolved.

CONCLUSIONS
Optic neuropathy is a potentially vision-threatening complication of epi-LASIK. Barotrauma from a transient increase in intraocular pressure created by the suction ring can be an important factor in this entity. [J Refract Surg. 2008;24:204-208.]

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PostPosted: Fri Mar 14, 2008 9:08 pm 
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Not peer-reviewed:

High-pressure vacuum during LASIK by Matt Young, EyeWorld, December 2007

?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

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The following are peer-reviewed:

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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.

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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.
Fundac?on Ver, C?rdoba, 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.

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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.

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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, Sch?pfer 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.

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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.

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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.

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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.

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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, Ju?rez CP, Reviglio VE.
Department of Ophthalmology, Fundaci?n VER, C?rdoba, 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.

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Am J Ophthalmol. 2004 Oct;138(4):657-9. Links
Macular hemorrhage after laser in situ keratomileusis (LASIK) with femtosecond laser flap creation.
Principe AH, Lin DY, Small KW, Aldave AJ.
Cornea Service, Jules Stein Eye Institute, University of California Los Angeles Medical Center, Los Angeles, California 90095, USA.

PURPOSE: To report the first case of macular hemorrhage following laser in situ keratomileusis (LASIK) with femtosecond laser flap creation.

DESIGN: Observational case report.

METHODS: A 36-year-old woman underwent uncomplicated, bilateral, simultaneous LASIK procedures for correction of moderate myopia (-5.00 diopters OD and -6.00 diopters OS). LASIK flap creation was performed using the IntraLase femtosecond laser.

RESULTS: On postoperative day 1, the patient's uncorrected and best-corrected visual acuities were 20/20 OD and 20/40 OS. A dilated fundoscopic examination revealed a one-third disk diameter macular hemorrhage OS. An intravenous fluorescein angoiogram ruled out the presence of predisposing macular pathology. Two months after LASIK, the macular hemorrhage had cleared, and 6 months later, the BCVA improved to 20/25 OS.

CONCLUSIONS: Macular hemorrhage may occur after LASIK, even in the absence of previously identified risk factors, such as high myopia, pre-existing choroidal neovasculaization, lacquer cracks, and sudden changes in intraocular pressure associated with microkeratome-assisted flap creation.
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J Refract Surg. 2003 Sep-Oct;19(5):534-47.Links
Incidence of retinal disease following refractive surgery in 9,239 eyes.
Ruiz-Moreno JM, Ali? JL.
Department of Ophthalmology, Miguel Hern?ndez University School of Medicine, Instituto Oftalmol?gico de Alicante, Alicante, Spain. jm.ruiz@umh.es

PURPOSE: To analyze the appearance, incidence, and characteristics of retinal diseases in myopic patients after refractive surgery.

METHODS: We studied retinal disease observed in 9,239 consecutive eyes (5,099 patients) after refractive surgery. Photorefractive keratectomy (PRK) was used to correct myopia in 5,936 eyes (3,184 patients, mean age 30.5 +/- 8.9 years); mean spherical equivalent refraction was -4.71 +/- 2.80 D. Laser in situ keratomileusis (LASIK) was used to correct myopia in 3,009 eyes (1,734 patients, mean age 32.0 +/- 7.8 years); mean spherical equivalent refraction was -13.5 +/- 3.30 D. An anterior chamber phakic intraocular lens (PIOL) was implanted to correct myopia in 294 eyes (181 patients, mean age 32.6 +/- 7.3 yr) with a mean spherical equivalent refraction of -18.5 +/- 5.00 D.

RESULTS: Retinal detachment occurred at a mean 53.6 +/- 41.4 months after PRK in 9 eyes (0.15%), 24.6 +/- 20.4 months after LASIK in 11 eyes (0.36%), and 20.5 +/- 17.4 months after anterior chamber PIOL implantation in 12 eyes (4.08%). Choroidal neovascularization occurred a mean 26 months after PRK in 1 eye (0.01%), mean 30.2 +/- 19.3 months after LASIK in 10 eyes (0.33%), and mean 49.0 +/- 33.5 months after PACL implantation in 7 eyes (2.38%). One patient developed a macular hole 12 months after LASIK and another patient developed a macular hemorrhage immediately after LASIK. Epiretinal membrane appeared in one patient 19 months after anterior chamber PIOL implantation.

CONCLUSION: There was no relationship between PRK for myopia and retinal disease. LASIK for correction of myopia was followed by a low incidence of retinal disease; additional study is necessary to assess the true impact of the suction ring in the myopic eye. Implantation of an anterior chamber PIOL to correct high myopia was followed by a low incidence of choroidal neovascularization, a high incidence of retinal detachment, similar to other intraocular interventions in highly myopic patients.

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J Cataract Refract Surg. 2000 Jun;26(6):922-4.
Macular hemorrhage after laser in situ keratomileusis for high myopia.
Ellies P, Pietrini D, Lumbroso L, Lebuisson DA.
Department of Ophthalmology, H?tel-Dieu de Paris Hospital, France.

We describe 2 women with high myopia of -12.0 and -18.0 diopters who presented with myopic macular hemorrhages 1 and 4 days, respectively, after being treated by laser in situ keratomileusis (LASIK). One hemorrhage was related to a pre-existing choroidal neovascularization and the other to the presence of lacquer cracks. The hemorrhages resolved but resulted in a permanent decrease in vision. A careful fundus examination should be conducted before performing LASIK in highly myopic patients. In cases of similar macular pathology, fluorescein angiography should be done before LASIK.

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J Refract Surg. 2000 May-Jun;16(3):371-2.
Premacular subhyaloid hemorrhage following laser in situ keratomileusis.
Mansour AM, Ojeimi GK.
Department of Ophthalmology, American University of Beirut, Lebanon. dr.ahmad@cyberia.net.lb

PURPOSE: To report a case of premacular subhyaloid hemorrhage following laser in situ keratomileusis (LASIK).

METHODS: Case report.

RESULTS: The subhyaloid hemorrhage did not resolve over 1 month of observation, necessitating Nd:YAG posterior hyaloidotomy.

CONCLUSION: The LASIK procedure can be associated with postoperative subhyaloid hemorrhage, presumably from rapid release of the microkeratome vacuum pressure.

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J Cataract Refract Surg. 2007 Jun;33(6):1101-3.
Bilateral cystoid macular edema after phacoemulsification in post-laser in situ keratomileusis eyes.
Chalioulias K, Tsaloumas M.
Sellyoak Hospital, Raddlebarn Road, Birmingham, West Midlands, United Kingdom. k_chal@hotmail.com

We report a case of a 66-year-old man who had bilateral laser in situ keratomileusis and 6 months later, uneventful simultaneous bilateral cataract surgery. One week postoperatively, the visual acuity was reduced and 4 weeks later, the patient was referred to our clinic with a macular hemorrhage in the right eye and bilateral cystoid macular edema. He was treated with bilateral sub-Tenon's triamcinolone, which had to be repeated in both eyes, and is still being followed.

------------------------------------------------

Graefes Arch Clin Exp Ophthalmol. 1999 Jul;237(7):611-3.
Bilateral macular hemorrhage after laser in situ keratomileusis.Luna JD, Reviglio VE, Ju?rez CP.
Fundacion VER, Correo Central, C?rdoba, Argentina. funver@powernet.com.ar

BACKGROUND: This is the first report of a bilateral submacular hemorrhage after LASIK surgery in an extreme myo pic patient. A 31-year-old man underwent bilateral surgery for correction of -16.75+0.75x70 degrees and -16.50+0.50x55 degrees.

METHODS: Case report.

RESULTS: One day after surgery the patient's uncorrected visual acuity was in the 20/50 range OU and by 17 days after surgery his visual acuity had declined to 20/200 range. Fundus examination showed multifocal subretinal macular and posterior pole hemorrhages. Fluorescein angiography showed some macular lesions compatible with lacquer cracks.

CONCLUSIONS: Preoperative and postoperative fundus examination is important to detect this phenomenon. Patients should be informed of this rare complication.

-------------------------------------------

Ann Ophthalmol (Skokie). 2006 Summer;38(2):139-40.
Hemi-retinal vein occlusion following LASIK.
Smith BT, Park CH, Fekrat S.
Barnes Retina Institute, St. Louis, MO, USA. smithbradleythomas@msn.com

We report a case of hemi-retinal vein occlusion following laser-assisted in situ keratomileusis (LASIK) in a healthy 46-year-old Caucasian male. A hemi-retinal vein occlusion following LASIK could be coincidental. However, young age, absence of risk factors and negative laboratory testing require consideration of a causal relationship.

-------------------------------------

Eur J Ophthalmol. 2003 Mar;13(2):139-46.
Complications of laser in situ keratomileusis (LASIK).
Tabbara KF, El-Sheikh HF, Vera-Cristo CL.
The Eye Center, The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia. k.tabbara@nesma.net.sa

PURPOSE: To report major complications associated with laser in situ keratomileusis (LASIK).

METHODS: Twenty-four eyes of 23 patients who underwent LASIK in different centers in Saudi Arabia were included. There were 9 women and 14 men. The age range was from 20 to 65 years. Nineteen of the 23 patients had been referred to the Eye Center for management. All patients had a complete ophthalmologic examination, refraction, corneal topography and pachymetry.

RESULTS: The 24 eyes of 23 patients had complications consequent to LASIK. Thirteen were intraoperative complications, and 11 postoperative. Ten (44%) of the 23 cases were related to the corneal flap, two (9%) with intraocular perforation with the microkeratome. Three (13%) had photoablation-related complications. Postoperative complications included three (13%) cases of infections, four (17%) stromal-interface related problems, one (5%) who developed interface vascularization, and one (5%) with non-ischemic central retinal vein occlusion.

CONCLUSIONS: Although LASIK is a safe and effective procedure, a small number of patients may suffer serious complications that can even lead to visual loss. The procedure must be carefully performed by qualified surgeons.

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This one doesn't have an abstract:

Retina. 2005 Jun;25(4):533-7.

Cilioretinal artery occlusion following laser in situ keratomileusis.
Ahmadieh H, Javadi MA.

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Ophthalmology 2001 Apr;108(4):660-5
Laser in situ keratomileusis-induced optic neuropathy.
Cameron BD, Saffra NA, Strominger MB.
Division of Ophthalmology, Maimonides Medical Center, Brooklyn, New York. Department of Ophthalmology, NYU Medical Center, New York, New York. Department of Ophthalmology, SUNY Health Science Center at Brooklyn, Brooklyn, New York.

OBJECTIVE: To report a case of bilateral optic neuropathy after bilateral laser-assisted in situ keratomileusis (LASIK) surgery.

DESIGN: Observational case report.

METHODS: Complete eye examination with detailed evaluation of the optic nerve, detailed medical history, stereo disc photographs, GDx Nerve Fiber Analyzer testing, Humphrey 24-2 SITA visual field testing, diurnal intraocular pressure measurement, serologic evaluation, and magnetic resonance imaging of the brain and orbits.

MAIN OUTCOME MEASURES: Optic nerve status, visual field status, and visual acuity.

RESULTS: A subject with previously healthy optic nerves had bilateral optic neuropathy develop after LASIK surgery. This neuropathy manifested with a subjective decrease in visual field, normal visual acuity, normal color vision, relative afferent pupillary defect, increased cupping of the optic nerve with focal neuroretinal rim defects, decreased nerve fiber layer thickness, and nerve fiber bundle-type visual field defects. The subject had no other risk factors for optic neuropathy. No other cause of neuropathy was identified.

CONCLUSIONS: Optic neuropathy is a potential vision-threatening complication of LASIK surgery. This complication may be due to barotrauma or ischemia related to extreme elevation of intraocular pressure by the suction ring. Careful examination of the optic nerve before and after LASIK surgery is warranted.

--------------------------------------------------------------------------------

Can J Ophthalmol. 2007 Feb;42(1):123-4.
Optic pit maculopathy after laser-assisted in situ keratomileusis.
Rodriguez-Coleman H, Schiff WM, Hwang JC, Speaker MG.
National Eye Institute, National Institutes of Health, Bethesda, MD, USA.

CASE REPORT: Optic disc pit is an embryological malformation of the optic nerve that occurs in less than one in 10,000 people. It is 10%-15% bilateral, and 25% to 70% of patients develop a neurosensory macular detachment within the 2nd to 4th decade.

COMMENTS: We report a case of unilateral optic disc pit maculopathy 2 months after laser-assisted in situ keratomileusis (LASIK) revision.

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Ophthalmic Surg Lasers Imaging. 2003 Jul-Aug;34(4):334-41.
Acute conformational changes in the optic nerve head with rapid intraocular pressure elevation: implications for LASIK surgery.
Piette S, Liebmann JM, Ishikawa H, G?rses-Ozden R, Buxton D, Ritch R.
Department of Ophthalmology, The New York Eye and Ear Infirmary, New York 10003, USA.

BACKGROUND AND OBJECTIVE: To investigate the effects of acute intraocular pressure (IOP) elevation on optic disc morphology.

PATIENTS AND METHODS: Ophthalmodynamometry was used to increase the IOP of normal, healthy eyes. Confocal scanning laser ophthalmoscopy of the optic nerve head using the Heidelberg Retinal Tomograph II (Heidelberg GmbH, Heidelberg, Germany) and IOP measurements were obtained before, during, and after IOP elevation.

RESULTS: Sixteen eyes of 16 normal volunteers (mean age, 32.8 +/- 11.9 years) were enrolled. Rim area, rim volume, cup area, cup volume, cup-to-disc ratio, mean cup depth, maximum cup depth, mean retinal nerve fiber layer (RNFL) thickness, and RNFL cross-sectional area showed significant changes during IOP elevation (all P < .05, paired t test). All measured parameters returned to their original values after pressure resolution (all P > .2) except mean RNFL thickness (P = .03).

CONCLUSION: Transient elevation of IOP results in measurable alterations in optic nerve head topography.

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J Cataract Refract Surg. 2000 Nov;26(11):1581-4.
Optic neuropathy associated with laser in situ keratomileusis.
Lee AG, Kohnen T, Ebner R, Bennett JL, Miller NR, Carlow TJ, Koch DD.
Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

PURPOSE: To report 4 cases of optic neuropathy following laser in situ keratomileusis (LASIK).

SETTING: Tertiary Care ophthalmic practices.

METHODS: In this retrospective observational case series, 4 patients who developed acute visual loss following LASIK are reported. All had clinical evidence of optic neuropathy. Two had optic disc edema and 2 had normal appearing optic discs initially. None of the patients experienced significant visual recovery, and all developed optic atrophy in the affected eye.

RESULTS: All patients had evaluations for alternative etiologies of their optic neuropathy, with negative results. All patients were therefore presumed to have experienced an ischemic optic neuropathy following LASIK.

CONCLUSIONS: Patients who have LASIK may experience an acute anterior or retrobulbar optic neuropathy. The etiology is unknown but may be related to the marked increase in intraocular pressure that occurs during a portion of the procedure.

_________________
Broken Eyes

"The price good men pay for indifference to public affairs is to be ruled by evil men." Plato


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