Choroidal neovascularization in a young, healthy eye after LASIK

BACKGROUND

Choroidal neovascularization (CNV) is associated with age-related macular degeneration (AMD), degenerative myopia, angioid streaks, presumed ocular histoplasmosis syndrome, and numerous other ocular and systemic conditions. Idiopathic CNV is also a common form of the condition. However, CNV has rarely been noted after laser-assisted in situ keratomileusis (LASIK) and a cause-and-effect relationship has not been found. A case of CNV after uneventful LASIK is reported here, along with a literature review of previously reported cases and suggested pathophysiology. A link between LASIK and CNV is sought.

METHODS

A case report of CNV in a young, healthy eye after uneventful LASIK is presented. Review of the pertinent literature reporting a relationship between LASIK and CNV was conducted through 2007, and few studies are reported after 2005.

CONCLUSION

To date, there is anecdotal evidence of CNV after LASIK. The incidence from prior reports ranges from 0.003% to 0.33%. However, a causal link cannot be disregarded and merits further study. Each patient undergoing LASIK warrants a thorough preoperative dilated fundus examination, including a thorough examination of the macula. This occurrence, albeit rare, should be considered for inclusion in the refractive surgery consent form.

Preventing reactivation of ocular histoplasmosis: Guidance for patients at risk

BACKGROUND

Ocular histoplasmosis syndrome (OHS), a significant cause of vision loss in young and middle-aged adults, is associated with the fungus Histoplasma capsulatum (Hc). There is considerable evidence that recurrent reactivation of perimacular ocular histoplasmosis lesions is an important cause of disease progression and that vision loss is at least, in part, a consequence of host sensitivity to fungal antigen.

METHODS

The etiology and pathogenesis of OHS is reviewed and specific recommendations are made for patients with OHS that may decrease the risk of reactivation of ocular histoplasmosis lesions and slow disease progression.

CONCLUSION

Patients with perimacular chorioretinal scars secondary to OHS should be informed by the clinician that they are at risk for vision loss; they should be told the symptoms of choroidal neovascularization and how to self-monitor their vision with an Amsler grid. We recommend they also be instructed on how to decrease their risk of reinfection by Hc. Aggressive treatment of dermatomycoses, onychomycosis, vaginal candidiasis, and other chronic fungal infections may decrease the risk of reactivation of ocular lesions. Patients with OHS who are considering LASIK surgery should be informed that the procedure may trigger choroidal neovascularization.