Retinal Detachment Repair After LASIK
Even if the eyes of patients with high myopia become emmetropic as a result of refractive surgery, these patients need to be informed that their eyes remain at increased risk of retinal detachment. For this reason, symptoms such as floaters or photopsias warrant a thorough retinal evaluation with scleral depression to ensure that there are no peripheral retinal tears or holes. In addition, if vitreoretinal surgery or laser is deemed necessary, the vitreoretinal surgeon should ask about prior refractive surgery. Eyes undergoing retinal detachment repair after LASIK are prone to flap problems, including flap dehiscence, microstriae, and macrostriae. The surgeon may find it helpful to mark the edge of the flap prior to surgery to aid in flap replacement in case the flap is dislodged. The risk of flap problems increases dramatically if the epithelium is debrided during the retinal detachment repair. If flap dehiscence occurs, the flap should be carefully repositioned and the interface irrigated. A bandage contact lens may be placed at the end of the procedure.
Postoperatively, the patient should be observed closely for signs of flap problems such as epithelial ingrowth and diffuse lamellar keratitis, especially if an epithelial defect was present on the flap. After retinal detachment repair, the intraocular pressure (IOP) needs to be monitored, especially when an intraocular gas bubble is used, keeping in mind that IOP measurements may read falsely low after refractive surgery because of corneal thinning. In addition, elevated IOP can cause a diffuse lamellar keratitis–like picture or even a fluid cleft between the flap and the stroma, resulting in a misleading, extremely low IOP measurement (see Chapter 6). These problems are discussed in greater detail later in the chapter in the section Glaucoma After Refractive Surgery.
Qin B, Huang L, Zeng J, Hu J. Retinal detachment after laser in situ keratomileusis in myopic eyes. Am J Ophthalmol. 2007;144(6):921–923.
Wirbelauer C, Pham DT. Imaging interface fluid after laser in situ keratomileusis with corneal optical coherence tomography. J Cataract Refract Surg. 2005;31(4):853–856.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.