Retinal Detachment in Myopic Eyes After Laser in situ Keratomileusis

Assessment of the biometric modifications of the eye in LASIK during suction

PURPOSE

To study the biometric modifications of the eyeball during suction in Laser assisted in Situ Keratomileusis (LASIK).

METHODS

Observational and cross-sectional study. We studied 43 patients who underwent surgery for myopia and myopic astigmatism. Mean age was 38.3 ± 11.5 years, and 19 were female (44.2%). Conventional LASIK surgery with a manual microkeratome was performed. Before and during the suction maneuvre the following parameters were measured using an 11 Mhz biometric probe: aqueous depth (AQD), lens thickness (LT), vitreous cavity length (VCL) and axial length (AXL). Paired t-test was used to compare the biometric measurements before and during suction.

RESULTS

The mean spherical equivalent refractive error was -4.5 ± 2.3 diopters. During suction, the AQD did not change significantly (p = 0.231). However, AXL and VCL increased by 0.12 mm and 0.22 mm respectively (p = 0.039 and <0.01) and LT decreased by 0.20 mm (p < 0.01). AXL increased in 42% of the eyes and decreased in 16%, VCL increased in 70% of the eyes and decreased in 9%, and the LT was reduced in 67% of the eyes.

CONCLUSIONS

Suction maneuvres during LASIK surgery produce changes of little magnitude in the eye globe, mainly a decrease in LT and an increase in VCL and AXL. Therefore, these modifications are expected to produce minimal anatomic alterations.

Incidence and risk factors for retinal detachment following laser-assisted in-situ keratomileusis

Purpose:

The aim of this work was to study the incidence and potential risk factors for development of retinal detachment (RD) after laser-assisted in situ keratomileusis (LASIK) surgery over a long-term follow-up.

Methods:

This was a retrospective interventional case series. A total of 694 eyes of 352 patients were included who had undergone LASIK surgery at a tertiary eye care institute between January 2005 and September 2015 who had a minimum follow-up of 5 years after the surgery were included. Kaplan–Meier analysis and Cox proportion regression model was used to estimate the potential risk factors and cumulative risk for the development of RD.

Results:

Out of the total patients, 5 eyes developed RD after a mean follow-up of 7 years. The cumulative risk of RD after 1 year was 0.4%, after 2 years was 0.5% and after 7 years was 0.7%. Increased risk of RD was not associated with age at LASIK surgery, gender, laterality, and spherical equivalent (P > 0.05). A significantly increased risk for the development of RD was observed in eyes that were given prior prophylactic laser photocoagulation for peripheral lesions in multivariate cox proportional regression analysis with a hazard ratio (HR) of 9.33 (CI- 1.554-56.094; P = 0.015).

Conclusion:

We emphasize the need for a regular follow-up after the LASIK procedure to ensure timely treatment of any new retinal lesions.

Refractive enhancements for residual refractive error after cataract surgery

PURPOSE OF REVIEW

Advances in cataract surgery have allowed surgeons to achieve superior refractive outcomes but have also led to higher patient expectations. Despite ever-evolving technology, residual refractive errors still occur. Postcataract refractive enhancements may be required to deliver satisfactory visual outcomes. This review aims to discuss the potential causes of residual refractive errors and the various enhancement modalities to correct them.

RECENT FINDINGS

A thorough preoperative workup to detect and address underlying pathologic causes of impaired vision should be performed prior to enhancement or corrective procedures. Corneal-based procedures are the safest and most accurate methods of correcting mild cases of residual refractive error. Hyperopic, high myopic, and high astigmatic errors are best managed with lens-based enhancements. Piggyback intraocular lenses (IOLs) are safer and more effective compared with IOL exchange. Toric IOL rotation and IOL exchange are ideally performed in the early postoperative period.

SUMMARY

A multitude of options exist for effective correction of residual refractive errors. The choice on how to best manage these patients depends on many factors such as the cause of refractive error, type of IOL used, ocular comorbidities, and patient preference.

Outcomes of Vitreoretinal Surgery for Retinal Detachment after LASIK for Myopia

PURPOSE

To report and compare outcomes of vitreoretinal surgery for repair of retinal detachment in myopic patients with and without previous laser-assisted in situ keratomileusis (LASIK).

METHODS

This is a descriptive retrospective observational study with a control group for comparison that consisted of the analysis of clinical and surgical charts of patients who underwent vitreoretinal procedures for retinal detachment at the Fundación Oftalmologica Nacional between January 1995 and December 2002. The authors identified those myopic patients who had previous history of LASIK and an age- and myopia-matched control group without refractive surgery.

RESULTS

The sample contains 24 myopic eyes of 22 patients with previous LASIK and 23 myopic eyes without previous LASIK in the control group, matched by age and myopia. Mean refractive error was -9.4 D before LASIK for the cases group and -11.2 for the control group. Poor preoperative best-corrected visual acuity was present in 71% of cases and 61% of controls (p=0.489). Macula off retinal detachment was found in 17 eyes in both groups. Five eyes required at least two procedures, achieving 91% (20 eyes) reattachments at the end of follow-up in each group. Final best-corrected visual acuity was better than 20/100 in 15 eyes (62.5%) in the LASIK group and 17 eyes (74 %) in the control group (p=0.659).

CONCLUSIONS

Retinal detachment in patients with previous myopic LASIK has similar characteristics as in myopic patients without refractive surgery. Current vitreoretinal surgery is of good prognosis as the retina was successfully reattached in most cases in both groups.

The application of wide-field laser ophthalmoscopy in fundus examination before myopic refractive surgery

BACKGROUND

To evaluate wide-field laser ophthalmoscopy (Optomap 200Tx) for screening retinal lesions before myopic refractive surgery.

METHODS

Seventy-eight eyes of 78 consecutive refractive surgery candidates were included in this study. All subjects underwent Optomap 200Tx, mydriatic slit-lamp lens examination and the Goldmann three-mirror contact lens examination, which was considered as the reference method for determining retinal lesions.

RESULTS

Forty of 78 eyes had retinal lesions (51.28%) and three eyes had retinal breaks (3.85%), which were diagnosed by the Goldmann three-mirror contact lens examination. Compared to the Goldmann three-mirror contact lens examination, the detection rate with the Optomap 200Tx was 91.73%% for retinal lesions, while the detection rate of mydriatic slit-lamp lens exams was 81.20%. There were no statistically significant differences among the three methods used for the diagnoses of myopic conus, tessellation and retinal breaks(all p > 0.05). For peripheral retinal lesions, the detection rate of the Optomap 200Tx examinations were similar to the Goldmann three-mirror contact lens exams (all p > 0.05), but were higher than the results of slit-lamp lens examinations (all p < 0.05). Regarding the vitreoretinal adhesions, the Goldmann three-mirror contact lens examinations had higher detection rates than did the Optomap 200Tx examinations (p = 0.031).

CONCLUSIONS

The Optomap 200Tx examinations is a convenient and feasible method to determine fundus pathological changes in myopic patients, especially for patients who can not endure pupil dilation. In order to avoid misdiagnosis of peripheral retinal lesions, Goldmann three-mirror contact lens examination is needed.

Corneal Complications During and After Vitrectomy for Retinal Detachment in Photorefractive Keratectomy Treated Eyes

To evaluate the occurrence of late-onset corneal haze (LOCH) after vitrectomy for rhegmatogenous retinal detachment (RRD) in photorefractive keratectomy (PRK)-treated eyes. This observational cohort study comprised 13 eyes of 13 patients who underwent vitrectomy for RRD and who had been subjected to PRK years earlier. The occurrence of LOCH was evaluated together with all the preoperative, intraoperative, and postoperative factors that could affect final corneal status. LOCH developed in 2 eyes. Both patients had undergone PRK for high myopia--one 3 years and the other 9 years prior to RRD. Both patients presented with RRD due to giant retinal tear and were subjected to scleral buckle, 20-gauge vitrectomy, and silicone oil tamponade. Three months after vitrectomy and 1 month after silicone oil removal they both developed LOCH. During vitreoretinal surgery neither of the 2 patients needed mechanical epithelial debridement. Intraoperative epithelial debridement was performed in 2 of the other patients of the series, who had undergone previous PRK for high myopia and had clear corneas at presentation; in 1 of them this manoeuvre hampered intraoperative visualization. Follow-up after retinal detachment surgery ranged from 6 to 156 months (mean, 37.5 months). Subepithelial corneal scarring may be reactivated many years after PRK. In our series this happened after vitrectomy.

Rhegmatogenous retinal detachment after LASIK for myopia of up to -10 diopters: 10 years of follow-up

BACKGROUND

The aim of this work was to characterize rhegmatogenous retinal detachment (RRD) in over 22,000 eyes after laser-assisted in situ keratomileusis (LASIK) for the correction of myopia ≤ -10.00 diopters (D), its characteristics, and its frequency at 10 years of follow-up.

METHODS

This is a retrospective single-center interventional non-comparative case series. A total of 22,296 myopic eyes that underwent surgical correction of myopia ≤ -10.00 D were included. LASIK for the correction of myopia was performed in all eyes. Patients were followed for 10 years after LASIK. The clinical charts of patients that developed rhegmatogenous retinal detachment (RRD) after LASIK were reviewed.

RESULTS

A total of 11,594 (52%) eyes came back for follow-up after LASIK at 10 years. Twenty-two eyes (19 patients) developed a RRD after LASIK at 10 years. Rhegmatogenous retinal detachments occurred between 1 month and 10 years (mean: 31.6 ± 39.3 months) after LASIK. Eyes that developed a RRD had from -1.50 to -9.75 D of myopia (mean: -4.81 ± 2.2 D) before LASIK. The frequency of RRD after LASIK determined in our study was 0.05% (11/22,296) at 1 year, 0.15% (18/11,371) at 5 years, and 0.19% (22/11,594) at 10 years.

CONCLUSIONS

Rhegmatogenous retinal detachment after LASIK for the correction of myopia ≤ -10.00 D is infrequent. The risk of RRD after LASIK is very low if you screen patients, and do prophylactic treatment as performed in this study. RRD, if managed promptly, will result in good vision. We recommend that patients scheduled for refractive surgery undergo a very thorough dilated indirect funduscopy with scleral depression and treatment of any retinal lesion predisposing to the development of a RRD before LASIK surgery should be performed.

Immediate retinal detachment after laser in situ keratomileusis

PURPOSE

We report a case of rhegmatogenous retinal detachment immediately (first postoperative day) after the refractive surgery of laser in situ keratomileusis (LASIK).

CASE REPORT

A 50-year-old man underwent bilateral LASIK; on the first postoperative day, he presented with decreased visual acuity due to retinal detachment with vitreous hemorrhage in the left eye. There were two horseshoe tears posterior to the equator and one peripheral operculated hole, all temporally located. Four months later, he presented with vitreous hemorrhage and a horseshoe tear temporal posterior to the equator in the right eye.

RESULTS

Surgical treatment was done, and the retina reattached immediately after surgery and remained stable thereafter in both eyes. Six months after surgery, visual acuity was 20/30 in the left eye and 20/40 in the right eye.

CONCLUSION

Although the cause/effect relationship between LASIK and retinal detachment has not yet been established, occurrence of immediate postoperative retinal detachment may represent a strong temporal suggestion of its association.

Excimer laser refractive correction of myopia after episcleral buckling for rhegmatogenous retinal detachment

PURPOSE

To evaluate the long-term effects of excimer laser treatment for ametropia after surgical treatment of rhegmatogenous retinal detachment (RRD) with scleral buckles.

SETTING

Helsinki University Eye Hospital, Helsinki, Finland.

METHODS

Ten patients (10 eyes) who had 1 or more surgeries for RRD followed by refractive surgery for myopia were retrospectively enrolled in this study and were examined after excimer laser refractive surgery. Photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) was performed using a Star S2 excimer laser system (Visx). The best spectacle-corrected visual acuity (BSCVA), refraction, degree of anisometropia, and topographical changes were evaluated before and after the surgeries.

RESULTS

All patients were free of asthenopic symptoms after refractive surgery. At the end of the follow-up, a mean of 67 months +/- 14 (SD) after refractive surgery, 6 patients were within +/-1.0 diopter of the intended correction. Compared with previously reported cohorts of myopic patients, the achieved refraction in patients who previously had a scleral buckling procedure was worse. The postoperative refraction was stable, and corneal topography did not show induced scar formation, keratectasia, or irregular astigmatism. After refractive surgery, the BSCVA improved 1 Snellen line in 3 patients and 2 lines in 1 patient. One patient lost 1 Snellen line and another patient lost 2 lines. Four patients showed no changes. New retinal complications were not observed.

CONCLUSIONS

In the long-term, PRK and LASIK were safe methods for the treatment of myopia in RRD patients after scleral buckling. The predictability of myopic LASIK/PRK may be worse than generally reported in myopic cohorts.

Ocular Structure Changes During Vacuum by the Hansatome Microkeratome Suction Ring

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.

[Reactivation of ocular toxoplasmosis after laser in situ keratomileusis]

Laser in situ keratomileusis (LASIK) is a safe and efficient refractive surgical procedure that provides excellent results in most cases. Several complications have been reported, most of them related to the posterior segment of the eye. Although they are quite rare, a growing number of vitreoretinal pathologic conditions after LASIK have been reported. To date no article has reported an inflammatory or infectious disease of the posterior segment after a LASIK procedure. We report a case of reactivation of toxoplasmic chorioretinitis that occurred 5 days after a LASIK procedure. Clinical outcome was spontaneously favorable after 1 month, with no loss of vision. Although a causal effect between LASIK and toxoplasmic chorioretinitis reactivation cannot be proven with a single case report, we stress the importance of dilated fundus examination in LASIK preoperative assessment: our case suggests that in the presence of preoperative toxoplasmic chorioretinitis scars, increased retinal monitoring is required.

Long-term results of laser in situ keratomileusis for high myopia: Risk for ectasia

PURPOSE

To ascertain the long-term stability of laser in situ keratomileusis (LASIK) in highly myopic eyes.

SETTING

Clinical practice office-based surgery.

METHOD

Charts of eyes with high myopia who had LASIK surgery by the same surgeon between 1994 and 2000 were reviewed in 2003, and patients were given an appointment for follow-up examinations. In these highly myopic eyes, surgery was originally performed to create undercorrections with or without decreasing the ablation diameters to maximally conserve the residual stromal bed thickness.

RESULTS

Of the 107 eyes with myopia between -10.00 diopters (D) and -35.00 D reviewed and operated on in a 3-year period between 1994 and 1998, 35 eyes of 31 patients had a single enhancement procedure. One case of ectasia as a result of excessive tissue removal occurred in a patient with a preoperative refraction of -28.00 D. Of the 107 eyes reviewed, 78 (73%) were examined after 5 years, 68 (63%) after 7 years, and 15 (14%) between 9 years and 11 years.

CONCLUSIONS

Operating on eyes with highly myopic refractive errors and removing substantial tissue thickness did not produce ectasia in this series. Although high myopia has been considered a risk factor for post-LASIK ectasia, adherence to proper screening and intraoperative pachymetry appears to decrease the risk.

Acute rhegmatogenous retinal detachment immediately following laser in situ keratomileusis

We report a case of acute rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) surgery in a highly myopic patient. Fourteen hours postoperatively, the uncorrected visual acuity was counting fingers in the left eye. Slitlamp examination revealed significant anterior chamber reaction with fibrin-like material. Fundus examination revealed 2 inferior retinal horseshoe tears associated with an RD. Preoperative fundus examination with scleral depression may detect predisposing retinal lesions in highly myopic patients. Further study is required to evaluate the relationship between LASIK, acute postoperative RRD, and predisposing factors.

Complications of sequential keratorefractive and vitreoretinal surgery

We describe 2 complications of sequential keratorefractive and vitreoretinal surgery not previously reported. Epithelial ingrowth occurred in 1 patient who experienced laser in situ keratomileusis flap dehiscence and replacement during vitreoretinal surgery. In the second patient, a flap could not be created with a microkeratome or a femtosecond laser because of anatomical changes from previous vitreoretinal surgery. Anatomic repair of the vitreoretinal pathology and completion of keratorefractive surgery with good visual outcomes were achieved in both patients. Flap stability should be an important operative consideration for vitreoretinal surgeons; patients may have to be informed of the risk for and possible subsequent complications of iatrogenic flap dehiscence. Refractive surgeons operating on patients after vitreoretinal surgery may encounter difficulty creating a LASIK flap even with a femtosecond laser and may need to consider other keratorefractive options.

Décollements de rétine bilatéraux

PURPOSE

The purpose of our study was to evaluate the incidence of bilateral retinal detachments and to analyze the risk factors for it and the anatomic and functional results of treatment.

METHODS

Retinal detachment can be discovered in both eyes during an initial consultation. In other cases, retinal detachment may be seen in the second eye during follow-up of the first eye.

RESULTS

Bilateral retinal detachments account for 11.7% of the retinal detachments in our hospital. Many factors are involved in bilateral detachment, including myopia and degenerative lesions. Treatment depends on the type of detachment.

CONCLUSION

Treatment of bilateral detachments is difficult and depends on the specific type of detachment. Relatively young men are most at risk for bilateral detachments.

Rhegmatogenous Retinal Detachment After LASIK for Myopia

PURPOSE

To report the characteristics and incidence of rhegmatogenous retinal detachment in myopic eyes after LASIK.

METHODS

The medical records of 49 patients with rhegmatogenous retinal detachment after LASIK were reviewed. The incidence of rhegmatogenous retinal detachment after LASIK was determined and potential risk factors were evaluated.

RESULTS

LASIK was performed on 59,424 eyes with spherical equivalent refraction (SE) ranging from -0.75 to -26.50 diopters (D) (mean: -6.10 +/- 3.5 D). Forty-nine eyes developed rhegmatogenous retinal detachment between 1.5 and 76 months (mean: 27.3 +/- 21.7 months) after LASIK. The mean preoperative refractive error in these eyes was -8.6 +/- 3.9 D. Mean age of these patients was 38.2 +/- 11.2 years. Thirty-five (71.4%) patients were male. The cumulative incidence of rhegmatogenous retinal detachment was 0.082% (95% confidence interval [CI]: 0.061-0.109), and the yearly incidence was 0.032% (95% CI: 0.023-0.042) after LASIK. The most frequent location of the retinal breaks was the superior temporal quadrant (22.7%). Male sex, older age, and higher preoperative myopia were significantly related to the incidence of rhegmatogenous retinal detachment after LASIK (P<.001).

CONCLUSIONS

Based on the results of this study, following the treatment of high-risk peripheral retinal lesions, LASIK did not appear to be an additional risk factor for the development of rhegmatogenous retinal detachment after LASIK in our patients; however, patients should be informed of the possibility of this complication as a consequence of myopia. Patients who are male, older in age, and have high myopia preoperatively may be at increased risk.

Optic Disc and Retinal Nerve Fiber Layer Analysis With Scanning Laser Tomography After LASIK

PURPOSE

To examine whether LASIK induces changes in the optic disc and retinal nerve fiber layer using scanning laser tomography.

METHODS

Prospective, consecutive study of 53 myopic eyes in 38 patients (mean age: 35.7 +/- 10.4 years; range: 22 to 58 years). Preoperative average refractive error was -6.0 +/- 2.4 diopters (D) (spherical equivalent) (range: -2.0 to -10.0 D). Optic disc morphology and retinal nerve fiber layer thickness were evaluated with scanning laser tomography preoperatively and at 7 and 13 months postoperatively.

RESULTS

No statistically significant differences were noted between the pre- and postoperative optic disc and retinal nerve fiber layer measurements.

CONCLUSIONS

Our results suggest that transient extreme elevation of intraocular pressure during LASIK does not affect the optic disc morphology or retinal nerve fiber layer thickness in normal myopic eyes for at least 1 year after surgery.

Excimer laser surgery for correction of ametropia after cataract surgery

PURPOSE

To review the cases of patients who had excimer laser refractive surgery to correct unintentional or undesired ametropia after cataract extraction with intraocular lens (IOL) implantation.

SETTING

Wilmer Laser Vision Correction Center, Wilmer Eye Institute, Baltimore, Maryland, USA.

METHODS

In this retrospective noncomparative review of consecutive cases, the Wilmer Laser Vision Correction Center's database was searched for patients who had laser in situ keratomileusis or photorefractive keratectomy to correct ametropia after cataract extraction with IOL implantation.

RESULTS

Using the Visx Star excimer laser system (Visx, Inc.), 11 procedures were performed in 11 eyes of 10 patients a mean of 47 months (range 2 to 216 months) after cataract extraction with IOL implantation. Except for 1 patient with a silicone plate lens, all patients received 3-piece poly(methyl methacrylate) lenses. The mean age at time of excimer treatment was 75 years (range 70 to 81 years). Before laser surgery, the mean spherical equivalent of patient eyes was -3.76 diopters (D) +/- 2.50 (SD) (range -6.50 to +0.75 D), spherical refraction ranged from -9.00 D to plano, and the highest cylindrical refraction was +5.50 D. At last follow-up (mean 12.2 months; range 1 to 38 months), the mean manifest spherical equivalent was -0.88 +/- 1.43 D (range -2.75 to +2.13 D). Changes in mean manifest spherical equivalent were highly significant (P = .03, Wilcoxon signed rank test for paired values). There was no difference between targeted and achieved postoperative refraction (P = .34, Wilcoxon test). Increasing age was correlated with a hyperopic shift (r = 0.525, P = .05). All patients were satisfied with their final uncorrected visual acuity (UCVA), which improved in every case. Except for 1 patient in whom an epiretinal membrane developed, best spectacle-corrected visual acuity remained unchanged or improved.

CONCLUSIONS

In this series of patients, who were a few decades older than the typical excimer laser candidate, laser refractive surgery was a safe, effective, and predictable method to correct ametropia after cataract extraction with IOL implantation. It may be a viable, noninvasive alternative to intraocular surgery, which has potential complications. Although satisfactory for all patients, final UCVA was not as high as that reported in laser refractive surgery patients in general, and this result may be because of prior cataract extraction with IOL implantation or increased age.

Retinal complications after laser-assisted in situ keratomileusis (LASIK)

PURPOSE OF REVIEW

This paper reviews the retinal complications that may occur after laser-assisted in situ keratomileusis (LASIK).

RECENT FINDINGS

During the review period (1 year), several nonrandomized retrospective studies and case reports/series were published. One study was performed to determine the efficacy and safety of prophylactic laser photocoagulation for retinal breaks in patients with myopia undergoing LASIK. Retinal breaks were identified and treated in 39 eyes (2%). None of the patients developed a rhegmatogenous retinal detachment (RRD) (except one trauma case). Another group studied retinal disease observed in 9239 consecutive eyes after refractive surgery (including LASIK) and found RRD in 11 eyes (0.36%) and choroidal neovascularization (CNV) in 10 eyes (0.33%). Three reports described a total of 16 patients with a previously placed encircling scleral buckle for a RRD who had LASIK to correct myopia. In all patients, the visual acuity (VA) improved. Another study reported the characteristics and surgical outcomes of RRD in myopic eyes after LASIK (33 eyes of 27 patients; frequency 0.08% [33/38, 823]). They found that 45.8% lost two or more lines of VA after vitreoretinal surgery. Two letters described the characteristics and potential mechanisms of a macular lacquer crack (one with subsequent development of subfoveal CNV) in a myopic patients corrected by LASIK.

SUMMARY

Serious complications after LASIK are infrequent. A dilated fundus examination is very important before LASIK and in every patient whose VA after LASIK is not as good as expected to avoid delayed referral to a vitreoretinal specialist if necessary. Only prospective studies can determine whether the procedure exacerbates myopic pathology.