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

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.

Myopic retinal changes screening: comparison of sensitivity and specificity among 15 combinations of ultrawide field scanning laser ophthalmoscopy images

AIMS

To investigate the evaluation indices (diagnostic test accuracy and agreement) of 15 combinations of ultrawide field scanning laser ophthalmoscopy (UWF SLO) images in myopic retinal changes (MRC) screening to determine the combination of imaging that yields the highest evaluation indices in screening MRC.

METHODS

This is a retrospective study of UWF SLO images obtained from myopes and were analyzed by two retinal specialists independently. 5-field UWF SLO images that included the posterior (B), superior (S), inferior (I), nasal (N) and temporal (T) regions were obtained for analysis and its results used as a reference standard. The evaluation indices of different combinations comprising of one to four fields of the retina were compared to determine the abilities of each combinations screen for MRC.

RESULTS

UWF SLO images obtained from 823 myopic patients (1646 eyes) were included for the study. Sensitivities ranged from 50.0% to 98.9% (95% confidence interval (CI), 43.8-99.7%); the combinations of B+S+I (97.3%; 95% CI, 94.4-98.8%), B+T+S+I (98.5%; 95% CI, 95.9-99.5%), and B+S+N+I (98.9%; 95% CI, 96.4-99.7%) ranked highest. Furthermore, the combinations of B+S+I, B+T+S+I and B+S+N+I also revealed the highest accuracy (97.7%; 95% CI, 95.1-100.0%, 98.6%; 95% CI, 96.7-100.0%, 98.8%; 95% CI, 96.9-100.0%) and agreement (Kappa = 0.968, 0.980 and 0.980). For the various combinations, specificities were all higher than 99.5% (95% CI, 99.3-100.0%).

CONCLUSION

In our study, screening combinations of B+S+I, B+T+S+I and B+S+N+I stand out with high-performing optimal evaluation indices. However, when time is limited, B+S+I may be more applicable in primary screening of MRC.

Screening and prophylaxis of retinal degenerations prior to refractive surgery

The need and demand for surgical correction of refractive errors, particularly myopia, has been increasing. Degenerations involving the peripheral retina are common in myopes and can result in a rhegmatogenous retinal detachment. There are no clear guidelines for retinal screening and management of asymptomatic retinal degenerations prior to refractive surgery or for follow-up of these patients. This article aims to provide a set of guidelines for the management of retinal degenerations in eyes undergoing refractive surgeries.

Factors associated with myopia in Korean children: Korea National Health and nutrition examination survey 2016-2017 (KNHANES VII)

BACKGROUND

To evaluate the prevalence and risk factors associated with myopia and high myopia in children in South Korea.

METHODS

A total of 983 children 5-18 years of age who participated in the Korean National Health and Nutrition Examination Survey 2016-2017 (KNHANES VII), a nationwide population-based cross-sectional study, were evaluated. Myopia and high myopia were defined as a spherical equivalent (SE) ≤ - 0.5 diopters (D) and SE ≤ --6.0 D. The association between refractive errors and potential risk factors for myopia was analyzed.

RESULTS

The prevalence of myopia and high myopia was 65.4 and 6.9%, respectively. Older age and parental myopia were significantly associated with both myopia and high myopia, while higher body mass index (BMI) was associated with high myopia only. Although the proportion of subjects who spent more time on near work activities (≥4 h/day) was sequentially increased with increased refractive error, this tendency was not statistically significant by multivariable logistic regression.

CONCLUSIONS

Korean children had a high prevalence of myopia and high myopia. In this age group, the risk of myopia increased with aging and parental myopia. Higher BMI may be associated with high myopia.

Knowledge, attitude, and practice about myopia in school students in Marat city of Saudi Arabia

Background:

The prevalence of youth myopia has increased significantly in the local communities of Saudi Arabia; school children and parents are unaware of the knowledge and complications of myopia.

Objective:

To initiate and increase the awareness of myopia among school students and to prevent future complications.

Method:

An organized, questionnaire with 14 questions was prepared to analyze the school students’ knowledge attitudes and practice about myopia. The study was conducted in a local school in Marat city, Saudi Arabia, between April 2019 and September 2019. The sample size includes 100 male students of age group 7 years to 14 years.

Results:

82% of students have heard about myopia with the majority source of information being parents (62%) and teachers (35%). 45% of the students reported a negative attitude toward the eye-glasses users. 20% of students have reported the use of eye-glasses. Most of the students reported uncomfortable feel and shyness due to wearing of eye-glasses which limits their use.

Conclusion:

The public awareness programs by the local governing bodies, local hospitals, health workers, medical colleges, and non-government organizations should be organized in each local school to increase the school students’ knowledge, positive attitude, and practice toward myopia.

The high prevalence of myopia in Korean children with influence of parental refractive errors: The 2008-2012 Korean National Health and Nutrition Examination Survey

The present study was conducted to investigate the effect of parental refractive errors on myopic children in Korean families using a nationally representative survey. We used the ophthalmologic examination dataset of the Korean National Health and Nutrition Examination Surveys IV and V, a nationwide population-based cross-sectional study using a complex, stratified, multistage, probability cluster survey, which were performed from 2008–2012. We included 3,862 children from 5–18 years of age from 2,344 families without any ocular trauma, surgical history, or cataract affecting refractive errors. The generalized estimating equation was conducted to assess the association of refractive errors among children and their parents. Among 3,862 children, 2,495 had myopia, which was 64.6% prevalence. There were 208 children with high myopia (5.4%). The prevalence rate ratio (PRR) for pediatric myopia and high myopia with myopic parents was 1.34 (95% confidence intervals [CI] 1.24–1.45) and 3.11 (95% CI 1.93–5.01), respectively. The PRR of myopia and high myopia in children significantly increased to 1.37 (95% CI 1.04–1.81) and 11.41 (95% CI 6.24–20.88), as the degree of parental myopia increased (P < 0.001, respectively). Children with two myopic parents were more myopic than those with only one myopic parent (P < 0.001, respectively). In addition to parental myopia, the age of the child and household income were also significant risk factors for all degrees of pediatric myopia in a family (P ≤ 0.005, respectively). In conclusion, Korean children showed high prevalence of myopia. Children with myopic parents showed a significantly greater risk for myopia and high myopia.

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.

Bilateral Simultaneous Rhegmatogenous Retinal Detachment following Laser in situ Keratomileusis

A 21-year-old woman developed simultaneous rhegmatogenous retinal detachment after laser in situ keratomileusis (LASIK) in both eyes. She underwent pars plana vitrectomy surgery combined with endolaser photocoagulation and silicone oil tamponade in the right eye. A week later, pneumatic retinopexy was done in the left eye. As the retinal tear did not seal, 360° scleral buckling surgery was performed and retina was attached. Bilateral simultaneous rhegmatogenous retinal detachment after LASIK for correction of myopia can be a serious complication. Patients should be informed about the possibility of this complication.

Comparison of retinal detachment surgery outcome among patients undergoing pars plana vitrectomy with and without relaxing retinotomy

The purpose of this four year retrospective study was to compare the anatomical and functional outcomes of complicated retinal detachment (RD) surgery by pars plana vitrectomy (PPV) with and without retinotomy. The main outcome measures were primary anatomical success (defined as retinal re-attachment at the final follow-up after a single operation, with or without silicone in situ), final anatomical success, final best-corrected visual acuity (BCVA) and postoperative complications. Baseline characteristics did not differ between the groups, although there was a borderline significant trend for the retinotomy group to be associated with worse pre-surgical ocular pathology. With a mean follow-up of 18 (± 7.8) months, primary anatomical success was achieved in 76.7% (33 of 43) of the retinotomy group eyes vs. 67.8% (40 of 59) of the eyes in the group without retinotomy. Final anatomical success rates for the retinotomy group and no retinotomy group were 100 and 93.2% respectively. The final BCVA was 1.57 LogMAR with retinotomy and 1.38 without retinotomy, an improvement in both groups. The incidence of postoperative complications was similar in the two groups, while the frequency of macular holes was higher in the retinotomy group. A similar degree of improvement in BCVA following both surgeries indicates their similar efficacy and justifies their performance even in complicated eyes in order to improve the patients' quality of life. With neither approach superior to the other, the choice of method should be left to the surgeon.

Characteristics of rhegmatogenous retinal detachment after refractive surgery: comparison with myopic eyes with retinal detachment

PURPOSE

To evaluate the characteristics of rhegmatogenous retinal detachment (RD) in patients with previous laser in situ keratomileusis (LASIK) and compare them to RD in patients with previous laser assisted subepithelial keratomileusis (LASEK) and myopic patients with no previous refractive surgery.

DESIGN

Retrospective, comparative case series.

METHODS

In 106 eyes of 106 patients with RD, patients with previous refractive surgery included 21 eyes after LASIK and 13 eyes after LASEK; 72 myopic patients with refractive errors of -3.0 diopters or less were grouped as the R (-) group. Characteristics of RD included distribution of RD and associated retinal breaks, location and number of retinal breaks, presence of lattice degeneration, and axial lengths.

RESULTS

The mean interval between refractive surgery and the onset of rhegmatogenous RD was 63.7 ± 43.5 months, occurring across a broad spectrum of time intervals. There were no significant differences among the LASIK group, the LASEK group, and the R (-) group in axial length (26.8 mm vs 26.4 mm vs 26.9 mm, respectively); in mean number of retinal holes/tears, (2.1/1.5, 0.9/1.4, 1.5/1.6, respectively); or in the presence of lattice degeneration (52.4% vs 46.2% vs 43.1%, respectively). Distribution of RD and associated retinal breaks were also not significantly different; retinal holes and tears were more prevalent in the temporal quadrants, and inferotemporal quadrants were the most commonly detached areas in both the LASEK and LASIK groups and in the R (-) group.

CONCLUSIONS

Myopia is a well-known risk factor for rhegmatogenous RD and may contribute more to the development of RD in myopic patients after refractive surgery, rather than refractive surgery itself.

Update on retinal detachment surgery

PURPOSE OF REVIEW

Update on controversies in the surgical management of rhegmatogenous retinal detachment.

RECENT FINDINGS

There are multiple new reports regarding the development and management of retinal detachment. Current use of oral fluoroquinolones may be associated with onset of retinal detachment, although the clinical relevance of this correlation is uncertain at this time and the finding has not been replicated in subsequent studies. Pars plana vitrectomy (PPV) continues to demonstrate efficacy as a primary treatment for retinal detachment, especially in pseudophakic patients. In many patients with macula-on retinal detachment, scheduling surgery after a short time delay is not necessarily deleterious and may actually be beneficial. Novel surgical tools, including bioerodible scleral buckling materials and artificial vitreous substitutes, are being investigated.

SUMMARY

Retinal detachment remains an important cause of visual loss. Although current surgical techniques demonstrate high rates of anatomic and visual success, further advances will probably benefit patients with retinal detachment.