Management of Complications in Refractive Surgery by Jorge L. Alio & Dimitri T. Azar

Author:Jorge L. Alio & Dimitri T. Azar
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Recently, Neo et al. reported three cases of CNV post-LASIK for myopia which were treated with a combination of intravitreal anti-vascular endothelial growth factor (anti-VEGF) and PDT with verteporfin [72]. The time from LASIK to development of CNV varied from 1 to 18 weeks, and all three patients had classic CNV as documented on fluorescein angiography. One of the patients had laser photocoagulation for juxtafoveal CNV 10 years earlier and had a development of new extrafoveal CNV at the edge of the photocoagulation scar, whereas the other two did not have a history of CNV. Patients received one to three intravitreal injections of ranibizumab as well as one to two sessions of PDT until resolution of CNV. Final visual acuity ranged from 0 to 0.3 (equivalent to 20/20 to 20/40). Currently, anti-VEGF monotherapy would be the treatment of choice.

Choroidal neovascularization is related to myopia itself, and its incidence varies from 4 to 11% in patients with high myopia. In addition, lacquer cracks have been found to be associated to CNV in up to 82% of cases with myopia [77]. Theoretically, when a break in Bruch’s membrane occurs, it allows the progression of the neovascular complex under the retina. The increase in intraocular pressure (IOP) to levels over 60 mmHg during suction with the microkeratome suction ring up to 4 mm posterior to the limbus may exert traction and compression posteriorly. In addition, we have to consider that the excimer laser generates a shock wave that is transmitted to the eye. These mechanisms may increase the gap in Bruch’s membrane further if there is already a lacquer crack. We believe that in patients with high myopia and lacquer cracks, LASIK should be considered contraindicated and an alternative method of refractive surgery offered.

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