Retina Today - Managing Retinal Detachment After Refractive Surgery (April 2017)

摘要

Refractive surgery has become popular for correcting ametropias, but it can lead to a variety of complications (Figures 1 - 4).1-35 Hofman et al,2 Sanders et al,3 and Feldman et al4 have described retinal detachment (RD) after radial keratotomy. Rodriguez and Camacho5 reported on 14 eyes (12 patients) that had either asymptomatic or symptomatic retinal breaks, subclinical and clinical rhegmatogenous RD (RRD), or both after corneal refractive surgery. Rodriguez et al,6 Barraquer et al,7 and Ripandelli et al8 have described RDs after refractive lens exchange for myopia correction. Ruiz-Moreno and associates reported the results of a clinically controlled study to investigate the rate of RD after implantation of phakic anterior chamber intraocular lenses.9 In that report, there was a 4.8% incidence of RD after implantation of a phakic anterior chamber intraocular lens for the correction of severe myopia. Our own most recent series demonstrated much lower incidences of RD after implantation of a Visian implantable collamer lens (ICL; Staar Surgical, 0.7%) or an Artisan iris-fixated intraocular lens (Ophtec, 0%).36 AT A GLANCE • Although LASIK has become one of the most popular options for the correction of low to moderate myopia, various types of complications have been associated with the procedure. • Because vitreoretinal surgery causes changes in corneal shape, thus damaging the refractive surgeon’s results, the author suggests that cryopexy, argon laser retinopexy, pneumatic retinopexy, or vitrectomy without a scleral band be performed when appropriate because these procedures tend not to change the shape or length of the globe. • It is very important to inform patients that LASIK corrects only the refractive aspect of myopia. Vitreoretinal complications in these eyes will occur, and only careful, large, prospective studies in patients can determine whether the procedure exacerbates myopic pathology. Laser-assisted in situ keratomileusis (LASIK) has become one of the most popular options for the correction of low to moderate myopia worldwide.10,11,35 Complications of LASIK that have been reported include optic neuropathy,12 undercorrection and overcorrection,13 flap displacement,14 epithelial ingrowth,15 flap melting,16 keratitis,17 retinal tear,18 RD,19 retinal phlebitis,20 corneoscleral perforation,21 retinal hemorrhage,21 macular hemorrhage,35 macular hole,22 serous macular detachment,23 choroidal neovascular membrane,21 reactivation of ocular toxoplasmosis,24 and irregular astigmatism. This report reviews retinal complications that may occur after refractive surgery, with an emphasis on RD after LASIK. RD AFTER LASIK A number of studies have described the occurrence of RD after LASIK.18,25,26 Ozdamar et al reported a case of bilateral RD associated with giant retinal tear after LASIK.25 Stulting and associates reported a case of RRD after LASIK for the correction of myopia.26 Faghihi et al reported an incidence of 0.082%,27 and Ruiz-Moreno and coworkers reported an incidence of 0.25% in myopic eyes after LASIK and mean BCVA of 20/45 after retinal repair surgery.19 Aras et al described 10 RDs in myopic eyes after LASIK, an incidence of 0.22%.1 Farah and colleagues reported on four eyes that had RRD within 3 months of LASIK for correction of high myopia.28 One case report details the development of an inferior RD due to two inferior horseshoe tears diagnosed 14 hours after LASIK surgery in a patient with -13 D of myopia.29 No causal relationship between LASIK and RD can be stated from these studies. LASIK may be associated with RD, particularly in highly myopic eyes. In myopic eyes, the yearly incidence of RD has been estimated to range from 0.015% to 0.075%, thought to be related to premature vitreous liquefaction and early posterior vitreous detachment.30 Figure 1. Fundus photo of a subtotal superotemporal and nasal macula-on RD after LASIK. Figure 2. Posto