Graefes Arch Clin Exp Ophthalmol (2012) 250:963–970
DOI 10.1007/s00417-011-1907-2
RETINAL DISORDERS
Rhegmatogenous retinal detachment after LASIK for myopia
of up to –10 diopters: 10 years of follow-up
J. Fernando Arevalo & Andres F. Lasave &
Francia Torres & Enrique Suarez
Received: 30 August 2011 / Revised: 23 November 2011 / Accepted: 13 December 2011 / Published online: 5 January 2012
# Springer-Verlag 2012
Abstract
Background The aim of this work was to characterize rheg-
matogenous 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 character-
istics, 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
Presented in part at the Club Jules Gonin Annual Meeting, Kyoto,
Japan, November 2010.
Supported in part by the Arevalo-Coutinho Foundation for Research in
Ophthalmology, Caracas, Venezuela.
The authors have full control of all primary data and agree to allow
Graefe’s Archive for Clinical and Experimental Ophthalmology to
review the data if requested.
J. F. Arevalo
Wilmer Eye Institute,
Johns Hopkins University School of Medicine,
Baltimore, MD, USA
J. F. Arevalo (*)
The Vitreoretinal Division, King Khaled Eye Specialist Hospital,
Al-Oruba Street, PO Box 7191, Riyadh 11462,
Kingdom of Saudi Arabia
e-mail: arevalojf@jhmi.edu
A. F. Lasave
The Retina and Vitreous Service,
Clinica Oftalmologica Centro Caracas,
Caracas, Venezuela
F. Torres : E. Suarez
The Centro Medico Docente La Trinidad,
Caracas, Venezuela
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. Rhegmatoge-
nous 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 infre-
quent. 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 fundu-
scopy with scleral depression and treatment of any retinal
lesion predisposing to the development of a RRD before
LASIK surgery should be performed.
Keywords –10 Diopters . Laser-assisted in situ
keratomileusis . LASIK . Myopia . Rhegmatogenous retinal
detachment . Ten years of follow-up
Introduction
The prevalence of myopia in the United States ranges from
25–46.4% of the adult population [1, 2]. In Asian popula-
tions, these proportions may be much higher, and in African
and Pacific Island groups, much lower. The market for
964
refractive surgery has a very large potential for people with
low (less than –5.00 diopters (D)) and moderate myopia
(–5.01 to –10.00 D), and most patients fall into one of these
two groups [2].
Laser-assisted in situ keratomileusis (LASIK) has be-
come one of the most popular options for the correction of
low to moderate myopia worldwide [3, 4]. However, this
procedure may lead to complications. There are several
studies and cases reported in the literature regarding retina
and vitreous complications or pathology after LASIK [5–9].
Kim and Jung [5] and Luna et al. [6] have reported a case of
macular hemorrhage after LASIK. Ozdamar et al. [7] have
reported a case of bilateral retinal detachment associated
with giant retinal tear after LASIK. Reviglio et al. [9]
reported a case of acute RRD after LASIK surgery in a
highly myopic patient, only 14 h after this procedure.
Ruiz-Moreno and coworkers [10] reported four retinal
detachments in myopic eyes after LASIK. Aras et al. [11]
reported ten retinal detachments in myopic eyes after
LASIK. We have previously reported our 2-year follow-up
of 29,916 eyes after LASIK for the correction of ametropias
(myopes and hyperopes). The incidence at 24 months of
vitreo-retinal pathology in our study was 0.06% including
13 rhegmatogenous retinal detachments (RRD) [12]. Re-
cently, Shu-Yen Lee et al. [13] reported ten patients out of
12,760 eyes (myopes and hyperopes) with RRD after laser
refractive surgery. These patients had a mean preoperative
measurement of –8.82±2.94 D (range –5.25 to –14.50 D).
The objective of this study is to characterize RRD in over
22,000 eyes after LASIK for the correction of myopia ≤ –10.00
D, its characteristics, and its frequency at 10 years of follow-up.
Materials and methods
We reviewed the medical records and obtained follow-up
information on all patients in our files with rhegmatogenous
retinal detachment (RRD) after LASIK for the correction of
myopia between December 1995 and December 1999 at
Centro Medico Docente La Trinidad in Caracas, Venezuela.
Approval was obtained from the Centro Medico Docente La
Trinidad Institutional Ethics Committee, and informed con-
sent was obtained for this study. In addition, this study was
performed in accordance with the ethical standards laid
down in the 1964 Declaration of Helsinki for research
involving human subjects. After a computerized search,
we determined that a total of 30,364 procedures (eyes) were
performed during the study period (4 years). The total
number of myopic eyes with and without astigmatism was
22,792 (75.06%). In addition, we determined that myopic
eyes with a correction ≤ –10.00 D were 22,296 (73.43%).
Those 22,296 eyes were the subjects of our retrospective
Graefes Arch Clin Exp Ophthalmol (2012) 250:963–970
study. Patients underwent surgical correction of myopia
from –1.50 to –10.00 D (mean: –4.50±3.70 D).
All patients’ preoperative examinations (by a retina special-
ist or a very experienced refractive surgeon) included a very
thorough dilated indirect funduscopy with scleral depression
and treatment (by a retina specialist) of any retinal lesion
predisposing to the development of an RRD before LASIK
surgery including symptomatic tears, any tear with significant
subretinal fluid, horseshoe tears in a fellow eye, and lattice with
holes or subretinal fluid in a fellow eye. If prophylactic treat-
ment of any retinal lesion predisposing to the development of a
RRD was performed before LASIK surgery, then surgery was
performed at least 1 month later. Patients were scheduled to be
seen during the first postoperative day, at 3 months, at
12 months, and yearly thereafter. A total of 11,594 (52%) eyes
came back for follow-up after LASIK at 10 years.
The clinical findings of 22 eyes (19 patients) with RRD
after LASIK for the correction of myopia ≤ –10.00 D are
presented. In addition, the frequency of rhegmatogenous
retinal detachment after LASIK and its characteristics (fun-
dus drawings of the 22 eyes were evaluated) at 10 years of
follow-up are also described.
Inclusion and exclusion criteria for selecting subjects to
undergo LASIK included patients with no history of prior
refractive surgery, keratoconus, prior cataract surgery, prolif-
erative diabetic retinopathy, or collagen vascular disease. Only
myopic eyes with a correction ≤ –10.00 D were included in
this study. Proparacaine HCL 1% drops were instilled into the
eye to be treated. A rigid eyelid speculum was used. Two
radial marks at the 12 and 5 o'clock positions were made with
gentian violet with an eight-point radial marker. The Chiron
automated corneal shaper (Bausch & Lomb Surgical, Clare-
mont, CA) or the Moria One microkeratome (Moria, Paris,
France) suction ring was placed in the eye concentric to the
pupil. The suction pump was activated to a pressure of 22–
24 mmHg. Intraocular pressures of approximately 60 mmHg
were verified using digital pressure or a Barraquer tonometer.
Several drops of the irrigating solution were instilled prior to
placement of the automated corneal shaper microkeratome
head. The microkeratome head was then placed into the
groove of the suction ring and a 160-μm flap was dissected
by activating the forward motion on the foot pedal. A slow
smooth pass was performed until the microkeratome reached
the permanent stop. Reverse action on the foot pedal permitted
retraction of the microkeratome head. The microkeratome
head and the suction ring were removed together, and the
corneal flap was elevated using a forceps or a spatula to
expose the underlying corneal stroma. A microsurgical
sponge was used to dry the stromal bed. The desired myopic
and toric treatment parameters were entered into the laser's
computer and laser ablation was then performed in the stromal
bed using the Coherent Schwind Keraton II (Coherent, Palo
Alto, CA, USA).
Graefes Arch Clin Exp Ophthalmol (2012) 250:963–970
In those eyes that developed an RRD, several techniques
were utilized to repair the retinal detachment. A pars plana
vitrectomy was performed in 12 cases using a Millennium
vitrectomy unit (Bausch & Lomb Surgical, Claremont, CA,
USA) or the ACCURUS® Surgical System (Alcon, Inc.,
Hünenberg, Switzerland). Three 1.0-mm-wide sclerotomies
were made using a microvitreal (MVR) blade from 2.5 to
3.5 mm posterior to the limbus. The infusion line was
sutured (not in cases performed with transconjunctival suture-
less vitrectomy techniques) in the infero-temporal quadrant.
After vitrectomy, sulfur hexafluoride (SF6) or perfluoropro-
pane (C3F8) gas was used in eight eyes, and Sil Oil 5000 or
1000 centistokes (cs) silicone oil (Richard-James, Inc., Pea-
body, MA) in four cases. In four patients, a scleral buckling
procedure was performed using a circumferential scleral band
(Mira 41; Mira, Waltham, MA) sutured. Argon laser retino-
pexy was performed using HGM's PC EDO argon (only
green) laser (HGM, Salt Lake City, UT) using the indirect
delivery system (LIO) and transscleral diode laser. Pneumatic
retinopexy was performed using the same argon laser (PC
EDO) with LIO and sulfur hexafluoride (SF6) or perfluoro-
propane (C3F8) as intraocular gas.
Results
Twenty-two eyes (19 patients) developed RRD after LASIK
for the correction of myopia ≤ –10.00 D. Our 19 patients had
an average age of 41.5±12.4 (22–70) years old. All patients
were Hispanic, and 12 (54.5%) were male. In our series, 1.5%
of the eyes did require some form of treatment of predisposing
retinal lesions before LASIK, but none of our patients that
developed a RRD after LASIK had previous prophylactic
treatment of retinal peripheral lesions. No patient had a history
of any other ocular surgery after 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. RRD devel-
oped in myopes from –1.50 to –9.75 D (mean: –4.81±2.2
D) after LASIK. Rhegmatogenous retinal detachments oc-
curred between 1 month and 13 years (mean: 31.6 ±
39.3 months) after LASIK. Retinal detachments were man-
aged with vitrectomy, cryoretinopexy, scleral buckling, ar-
gon laser retinopexy, and pneumatic retinopexy techniques.
Vitreo-retinal (VR) surgery was performed at a mean of
34.8±33.6 days (range: 7 days to 3 months) after the initi-
ation of RRD’s symptoms. Mean follow-up after VR sur-
gery was 8.7 ± 4.2 years (range: 1 month to 12 years).
Table 1 shows our patients' clinical findings, surgical man-
agement, and demographic data. Table 2 shows the number
of cases with RRD after LASIK per year, cumulative cases
per each year, and number of cases followed at each year up
to 10 years.
965
Retinal detachment characteristics
Fundus drawings of the 22 eyes were evaluated. Two
detachments were total, and 20 were sub-total (Fig. 1). Of
the 20 subtotal RRD, 11 had the macula off and nine were
macula on RRD. Of the 20 sub-total RRD, 11 involved
predominantly inferior quadrants and nine were predomi-
nantly superior RRD. An RRD involved more than one
quadrant in 15 out of 20 sub-total RRD. The infero-
temporal quadrant was involved in 11 of the sub-total
RRD in our series; the infero-nasal quadrant was involved
in six, the supero-temporal in six and the supero-nasal
quadrant in five cases (Fig. 2). The mean number of retinal
breaks per RRD was 3 (range: 1–9), including 43 holes, 22
horseshoe tears, and one retinal dialysis. Forty-eight
(71.6%) retinal breaks were located temporally and 19
(28.4%) were located nasally. Of the retinal breaks located
temporally, 31 (47%) were in infero-temporal sector and
between retinal breaks located nasally, ten (15%) were lo-
cated at infero-nasal sector (Fig. 3). The vitreous status was
only available from 11 of our cases, seven (63.6%) had
posterior vitreous detachment (PVD) and four (36.4%) had
no PVD. Only two (9%) of our RRD cases had a retinal tear
associated with lattice degeneration. Four (18%) of our
cases had proliferative vitreo-retinopathy (PVR) grade C.
Final best-corrected visual acuity (BCVA) after surgery
improved two or more lines in 57.1% of eyes but 31.8% of
the eyes had a final visual acuity (VA) of ≤20/200 (poor
VA). The reasons for poor visual in these patients included
epiretinal membrane (ERM), myopic maculopathy, PVR,
and optic atrophy. However, anatomic success with one
surgery was 100%.
A Kaplan–Meier curve was performed to evaluate the 10-
year event-free RRD survival. All patients (myopic eyes ≤ –
10.00 D) with a complete follow-up (10 years after LASIK)
were included. Therefore, the event-free RRD survival
curve for 11,594 myopic eyes ≤ –10 D that underwent
LASIK with 10 years of follow-up was 99.8% (Fig. 4).
Discussion
Refractive surgery is an accepted technique for correcting
myopia; however, this procedure might lead to complica-
tions. Hofman et al. [14], Sanders et al. [15], and Feldman et
al. [16] have described cases of RRD after radial keratot-
omy. Rodriguez and Camacho [17] reported 14 eyes (12
patients) that had either asymptomatic or symptomatic reti-
nal breaks, subclinical and clinical RRD, or both; seven after
automated lamellar keratoplasty (ALK) and seven after ra-
dial keratotomy. Rodriguez et al. [18], Barraquer et al. [19],
and Ripandelli et al. [20] have reported retinal detachments
after clear-lens extraction for myopia correction.
966 Graefes Arch Clin Exp Ophthalmol (2012) 250:963–970

Table 1 Demographic and general characteristics of 19 patients (22 eyes) with RRD after LASIK at 10 years of follow-up*

# Eye Gender Lat. Age (years) Pre-op Complications T after LASIK (months) Treatment
Rx

#1 M OS 22 (–) 2.50 RRD 2 PR

#2 M OD 50 (–) 2.50 RB, VH, SC RRD 12 ALR
#3 M OS 50 (–) 5.00 RRD 24 Scleral buckling
#4 F OS 37 (–) 2.50 RRD 10 Scleral buckling
#5 M OS 60 (–) 6.75 RRD 1 Scleral buckling
#6 F OD 48 (–) 9.75 Subclinical RRD 17 CRP
#7 M OD 39 (–) 9.00 RRD 25 Vitrectomy + Gas
#8 F OS 39 (–) 3.00 RRD 24 Vitrectomy + Gas
#9 F OD 40 (–) 3.00 RRD 4 ALR
#10 F OS 40 (–) 2.50 RRD 4 ALR
#11 F OS 37 (–) 1.50 RRD 2 Scleral buckling
#12 M OS 33 (–) 8.00 RRD 12 Vitrectomy + Gas
#13 M OS 36 (–) 4.50 RRD 36 Refused Surgery
#14 M OS 27 (–) 5.00 RRD and PVR 1 Vitrectomy + Oil
#15 M OD 27 (–) 7.00 RRD 5 Vitrectomy + Gas
#16 M OD 41 (–) 4.75 RRD 48 Vitrectomy + Gas
#17 F OS 48 (–) 4.75 RRD 72 Vitrectomy + SB + Gas
#18 M OD 34 (–) 4.00 RRD 48 Vitrectomy + SO
#19 F OD 59 (–) 3.00 RRD 12 Vitrectomy + SO
#20 F OD 70 (–) 4.75 RRD and PVR 120 Vitrectomy + SB + SO
#21 F OS 23 (–) 6.00 RRD and PVR 84 Vitrectomy + SO
#22 M OS 54 (–) 6.00 RRD 96 Vitrectomy + Gas

*# Pat0Number of eye; M0Male; F0Female; Lat0Laterality; OD0Right eye; OS0Left eye; LASIK0Laser in-situ keratomileusis; Pre-op Rx0
Preoperative refraction; T0Time; PR0Pneumatic retinopexy; ALR0Argon laser retinopexy; VH0Vitreous hemorrhage; PVR0Proliferative vitreo-
retinopathy;
SC0Subclinical; RRD0Rhegmatogenous retinal detachment; CRP0Cryoretinopexy; SB0Scleral buckling; SO0Silicone oil

Laser in situ keratomileusis has become a popular surgical some reports of RRD after LASIK surgery to correct myopia
option for the treatment of myopia [3, 4]. In Venezuela, about [6, 21, 22], and most cases involve patients with myopia
2,000 LASIK procedures are performed every month, and greater than –10.00 D. We have previously reported a 2-year
more than 80% of those eyes are myopes. There have been follow-up of 29,916 eyes after LASIK for the correction of

Table 2 Number of cases with rhegmatogenous retinal detachment (RRD) after LASIK per year, number of cases that actually showed for follow-
up, and cumulative cases per each year*

Years of F-U % of F-U (n) RRD cases per year (n) RRD cases per year (n) Cumulative

RRD cases (n) RRD (%) Freq. (%)

First 100 (22,296) 11 11 50 0.05

Second 100 (22,296) 3 14 63.6 0.06
Third 92 (20,512) 2 16 72.7 0.07
Fourth 40 (08,918) 2 18 81.8 0.20
Fifth 51 (11,371) 0 18 81.8 0.15
Sixth 67 (13,377) 1 19 86.4 0.14
Seventh 54 (12,040) 1 20 90.9 0.16
Eighth 56 (12,486) 1 21 95.5 0.16
Ninth 53 (11,817) 0 21 95.5 0.17
Tenth 52 (11,594) 1 22 100 0.19

*Years of F-U0years of follow-up; n0number of eyes with rhegmatogenous retinal detachment (RRD) after LASIK per year and cumulative cases
of RRD with their percentage (%) per each year; Freq0Frequency of rhegmatogenous retinal detachment
Graefes Arch Clin Exp Ophthalmol (2012) 250:963–970
Fig. 1 Rhegmatogenous retinal detachment (RRD) distribution. Two
RRD were total, and 20 were sub-total. The graph shows the subtotal
RRD distribution
ametropias. The incidence of vitreo-retinal pathology at 24
months in this study was 0.06% including 13 RRD [12].
Recently, Lee et al. [13] reported ten patients with RRD after
laser refractive surgery of 12,760 (myopes and hyperopes)
eyes, with a mean preoperative of –8.82±2.94 D (range –
5.25 to –14.50 D). These patients presented RRD after laser
refractive surgery at a mean interval of 23.8±22.5 months
(range; 3 months to 5 years and 8 months). In this study, the
incidence of RRD was 0.078% (ten out of 12,760 eyes) [13].
Qin et al. [23] investigated the incidence, characteristics, and
surgical management of RRD after LASIK surgery in myopia
in a retrospective, observational case series of RRDs observed
out of 18,342 eyes (9,598 patients). Patients were followed-up
for a mean of 20 months. They found that RRD developed in
six patients with an incidence of RRD after LASIK of
0.033%. The mean degree of pre-LASIK myopia in these eyes
was –9.33 diopters (range, –6.25 to –14.00 diopters). The
mean interval between LASIK and RRD development was
9.25 months.
The objective of our study was to characterize RRD after
LASIK for the correction of myopia ≤ –10.00 D, its surgical
Fig. 2 Of the 20 sub-total RRD, 11 involved predominantly inferior
quadrants and nine were predominantly superior RRD. An RRD in-
volved more than one quadrant in 15 of 20 sub-total RRD. The infero-
temporal quadrant was involved in 11 of the sub-total RRD, the infero-
nasal quadrant was involved in six, the supero-temporal in six and the
supero-nasal quadrant in five cases
967
Fig. 3 All retinal breaks included 43 holes, 22 horseshoe tears, and
one retinal dialysis. Forty-eight (71.6%) retinal breaks were located
temporally and 19 (28.4%) were located nasally. Retinal breaks distri-
bution is shown
outcomes, and its frequency at 10 years of follow-up. We
found 22,296 myopic eyes ≤ –10.00 D that underwent
LASIK in the study period. We acknowledge the lack of
complete follow-up on all patients in this study as our main
limitation. Only 52% of patients (11,594 eyes) completed
the 10-year follow-up visit. However, we analyzed and
compared the basal characteristics of patients with and with-
out complete follow-up. We found no significant differences
between both groups. Hence, we might say that patients
with or without follow-up were quite similar and, therefore,
we could assume a similar rate of RRD at 10 years in those
patients without follow-up. The event-free RRD survival
curve for 11,594 myopic eyes ≤ –10 D that underwent
LASIK with 10 years of follow-up was 99.8%. In addition,
50% and 63.6% of RRDs occurred during the first 1 and
2 years, respectively, when we had 100% of follow-up
(Table 2).
Retinal detachments were managed with vitrectomy, cry-
oretinopexy, scleral buckling, argon laser retinopexy, and
pneumatic retinopexy techniques. Rhegmatogenous retinal
detachments occurred at a mean of 31.6±39.3 months after
LASIK. The eyes that had developed a RRD after LASIK
Fig. 4 Kaplan–Meier survival curve. The event-free rhegmatogenous
retinal detachment (RRD) for 11,594 myopic eyes <10 D that under-
went LASIK with 10 years of follow-up was 99.8%
968
had a mean preoperative myopia of –4.81 D. Retinal de-
tachment characteristics in our study revealed that most
RRD and retinal breaks occur in the temporal quadrants
(71.6%). These are very interesting findings as the surgical
microkeratomes used in LASIK to create the corneal flap in
our study have a temporal handle that may be responsible
for an extra pressure on that side of the eye. The predomi-
nance of retinal breaks in the superior quadrants in RRD is
well known [24, 25]. However, to our knowledge, the spe-
cific retinal tear distribution of RRD in myopic eyes cannot
be extrapolated from previous studies.
Our findings are not generalizable to all myopic eyes
undergoing LASIK. Myopic eyes tend to develop lattice
degeneration, retinal breaks, and retinal detachments [26].
However, in contrast to clear-lens extraction [18–20], which
may influence RD, retinal breaks or detachments, may not
always be caused by LASIK. They are part of the natural
history of the myopic eye, and an expected complication
regardless refractive surgery. Anther factor influencing the
development of RRD in myopia is the longer axial length
[27]. Axial myopia, vitreous modifications, and peripheral
fundus abnormalities in myopic eyes are the major factors
predisposing to RRD [28]. There is a relationship between
the severity of myopia and the frequency of RRD [27, 28].
Reviglio et al. [11] reported a case of acute RRD after
LASIK surgery in a highly myopic patient with a manifest
refraction of –13.00 +3.00 × 15 in the right eye and –13.00+
3.00 × 170 in the left eye. Fourteen hours postoperatively,
the uncorrected visual acuity was counting fingers in the left
eye. Slit-lamp examination revealed significant anterior
chamber reaction with fibrin-like material. Fundus examination
revealed two inferior retinal horseshoe tears associated with an
RRD. The authors concluded that preoperative fundus exami-
nation with scleral depression might detect predisposing retinal
lesions in highly myopic patients. Ogawa et al. analyzed 1,116
RD cases and found that myopia was present in 82.16% of
them. In myopia higher than –15.00 D, the frequency of RD
was 68.6 times higher than for the hyperopic range [28]. Qin et
al. [23] investigated the incidence, characteristics, and surgical
management of RRD after LASIK surgery in myopia in a
retrospective, case series of RRDs observed of 18,342 eyes
(9,598 patients). Patients were followed-up for a mean of
20 months. They found that RRD developed in six patients.
The incidence of a RRD after LASIK in this study was 0.033%.
The mean degree of pre-LASIK myopia in these eyes was –
9.33 diopters (range, –6.25 to –14.00 diopters). The mean
interval between LASIK and RRD development was
9.25 months. All RRDs occurred spontaneously and were
managed with vitreoretinal surgeries. Retinal reattachment
was achieved at the first RRD surgery in all six eyes (100%)
at a mean follow-up of 9.3 months. Shu-Yen Lee et al. [13]
reported ten patients with RRD after laser refractive surgery of
12,760 eyes, with a mean preoperative of –8.82±2.94 D
Graefes Arch Clin Exp Ophthalmol (2012) 250:963–970
(range –5.25 to –14.50 D). Our findings show that the average
preoperative refraction in patients with RRD was –4.81 D.
However, our study only included patients with preoperative
refraction ≤ –10.00 D. In addition, the longer follow-up
allowed us to detect a larger number of RRD that occurred
between 1 month and 13 years after LASIK. Our mean aver-
age time LASIK to RRD is higher than in previous studies.
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. These numbers are
much lower than the incidence of retinal detachment in
myopes in general (0.7 to 6%) [27]. This finding is probably
explained by the fact that our refractive surgery patients un-
dergo preoperative examinations including a very thorough
dilated indirect funduscopy with scleral depression and treat-
ment of any retinal lesion predisposing to the development of a
RRD before LASIK surgery can be performed. We estimate
that about 1.5% of eyes in our series did require some form of
treatment of predisposing retinal lesions before LASIK. Al-
though it is interesting to note that none of our patients that
developed a RRD after LASIK had previous prophylactic
treatment of retinal peripheral lesions. However, due to the
retrospective nature of this study, we could not determine the
exact number of eyes treated with laser or cryotherapy prophy-
laxis before refractive surgery was performed. It would have
been interesting to establish the occurrence of posterior vitre-
ous detachments after laser refractive surgery, but we were
unable to do so with the limitations of a retrospective study.
Another important factor to take into consideration when
we evaluate our state of knowledge in this area is duration of
follow-up. Patients described with vitreo retinal pathology
after LASIK have been followed-up for limited time
(10 years in this study). It is reasonable to expect that the
incidence of RRD in the initial cohort of patients that had
LASIK will rise with time. It is possible that LASIK-
induced trauma might accelerate vitreous liquefaction and
that over the years these patients might have a higher incidence
of retinal detachments and other vitreo-retinal problems. This
may explain why the frequency of RRD after LASIK for the
correction of myopia in our study at a limited time (10 years) is
much lower than the incidence of retinal detachment in
myopes in general, which is a lifetime occurrence.
Another important limitation of our study due to its
retrospective nature is that the follow-up was not consistent,
and it is possible that other ophthalmologists saw patients
who developed a retinal detachment after LASIK.
Future prospective studies involving a large number of
myopic eyes, scheduled peripheral retinal exams, and ultra-
sound are desirable to determine the changes in the vitreo-
retinal interface after LASIK. In addition, prospective studies
are needed to confirm our results and to determine the need for
more aggressive prophylactic retinal therapy in this group of
eyes.
Graefes Arch Clin Exp Ophthalmol (2012) 250:963–970
We recommend that patients scheduled for LASIK must
be carefully examined with indirect ophthalmoscopy and
scleral depression under pupillary dilatation to detect any
myopic peripheral lesion (including symptomatic tears, any
tear with significant subretinal fluid, horseshoe tears in a
fellow eye, and lattice with holes or subretinal fluid in a
fellow eye) that requires immediate treatment before LASIK
can be performed. Such indication is justified by the fact
that vitreo-retinal surgery causes changes in corneal shape,
thus damaging the refractive surgeon's results [29]. We
suggest that cryopexy, argon laser retinopexy, pneumatic
retinopexy or small gauge vitrectomy without a scleral band
is performed when appropriate because they tend not to
change the shape or length of the globe. Another option in
case of scleral buckling procedures is to remove the exo-
plants early, as suggested by Rodriguez and Camacho [17],
after being sure that all breaks have sealed and that no RRD
is present anywhere in the fundus.
Simply correcting refractive errors surgically does not rep-
resent a cure for myopia. Patients who have had refractive
surgery to correct myopia should also be closely followed-up
by vitreo-retinal specialists to manage vitreo-retinal disorders
in originally myopic eyes. Retinal detachments have been
reported after laser refractive surgery, and the rates are low
in general, ranging from 0.05 to 0.25% [16–19]. Our previous
rate of 0.06% [12] and our actual rate of 0.19% similarly fall
within the reported range. It must be noted, however, that
these rates depend fundamentally on the duration of follow-
up after the laser procedure.
In summary, our study suggests that RRD after LASIK
for the correction of myopia ≤ –10.00 D is uncommon. The
risk of RRD after LASIK if you screen them, and do
prophylactic treatment as performed in this study is very
low. 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. Preoperative
examinations are necessary including a very thorough dilat-
ed indirect funduscopy with scleral depression and treatment
of any retinal lesion predisposing to the development of a
RRD. A dilated fundus examination is even more important
in every patient whose VA after LASIK is not as good as
expected to avoid delay in referral to vitreo-retinal special-
ist. Rhegmatogenous retinal detachments if managed
promptly will result in good vision. No cause-and-effect
relationship between LASIK and retinal detachment can be
proved from this study. However, it is very important to
inform patients that LASIK only corrects the refractive
aspect of myopia, and that it has the potential for serious
complications.
The authors have no financial or proprietary interests in any of the
products or techniques mentioned in this article.
969
References
1. Sperduto RD, Seigel D, Roberts J, Rowland M (1983) Prevalence
of myopia in the United States. Arch Ophthalmol 101:405–407
2. McCarty CA, Livingston PM, Taylor HR (1997) Prevalence of
myopia in adults: implications for refractive surgeons. J Refract
Surg 13:229–234
3. Pallikaris IG, Papatzanaki ME, Siganos DS (1991) A corneal flap
technique for laser in situ keratomileusis. Arch Ophthalmol
109:1699–1702
4. Zaldivar R, Davidorf JM, Oscherow S (1998) Laser in situ kerato-
mileusis for myopia from –5.50 to –11.50 diopters with astigmatism.
J Refract Surg 14:19–25
5. Kim HM, Jung HR (1996) Laser assisted in situ keratomileusis for
high myopia. Ophthalmic Surg Lasers 27:508–511
6. Ozdamar A, Aras C, Sener B (1998) Bilateral retinal detachment
associated with giant retinal tear after laser-assisted in situ kerato-
mileusis. Retina 18:176–177
7. Luna JD, Reviglio VE, Juarez CP (1999) Bilateral macular hem-
orrhage after laser in situ keratomileusis. Graefes Arch Clin Exp
Ophthalmol 237:611–613
8. Stulting RD, Carr JD, Thompson KP (1999) Complications of
laser in situ keratomileusis for the correction of myopia. Ophthal-
mology 106:13–20
9. Reviglio VE, Kuo IC, Gramajo L (2007) Acute rhegmatogenous
retinal detachment immediately following laser in situ keratomi-
leusis. J Cataract Refract Surg 33:536–539
10. Ruiz-Moreno JM, Perez-Santoja JJ, Alio JL (1999) Retinal detach-
ment in myopic eyes after laser in situ keratomileusis. Am J
Ophthalmol 128:588–594
11. Aras C, Ozdamar A, Karacorlu M (2000) Retinal detachment
following laser in situ keratomileusis. Ophthalmic Surg Lasers
31:121–125
12. Arevalo JF, Ramirez E, Suarez E (2000) Incidence of vitreo-retinal
pathologic conditions 24 months after laser-assisted in situ kerato-
mileusis (LASIK). Ophthalmology 107:258–262
13. Lee SY, Ong SG, Yeo KT, Wong DW, Ang CL (2006) Retinal
detachment after laser refractive surgery at the Singapore National
Eye Centre. J Cataract Refract Surg 32:536–538
14. Hofman RF, Starling JC, Hovland KR (1985) Case report:
retinal detachment after radial keratotomy surgery. J Refract
Surg 1:226
15. Sanders DR (1986) Refractive Corneal Surgery. In: Hofman RF,
Salz JJ (eds) Thorofare. NJ, Slack Inc, p 388
16. Feldman RM, Crapotta JA, Feldman ST, Goldbaum MH (1991)
Retinal detachment following radial and astigmatic keratotomy.
Refract Corneal Surg 7:252–253
17. Rodriguez A, Camacho H (1992) Retinal detachment after refrac-
tive surgery for myopia. Retina 12:S46–S50
18. Rodriguez A, Gutierrez E, Alvira G (1987) Complications of
clear lens extraction in axial myopia. Arch Ophthalmol 105:1522–
1523
19. Barraquer C, Cavelier C, Mejia LF (1994) Incidence of retinal
detachment following clear-lens extraction in myopic patients:
retrospective analysis. Arch Ophthalmol 112:336–339
20. Ripandelli G, Billi B, Fedeli R, Stirpe M (1996) Retinal detach-
ment after clear lens extraction in 41 eyes with high axial myopia.
Retina 16:3–6
21. Arevalo JF, Ramirez E, Suarez E (2001) Rhegmatogenous retinal
detachment in myopic eyes after laser in situ keratomileusis; fre-
quency, characteristics, and mechanism. J Cataract Refract Surg
27:674–680
22. Arevalo JF, Ramirez E, Suarez E (2002) Retinal detachment in
myopic eyes after laser in situ keratomileusis. J Refract Surg
18:708–714
970
23. Qin B, Huang L, Zeng J, Hu J (2007) Retinal detachment after
laser in situ keratomileusis in myopic eyes. Am J Ophthalmol
144:921–923
24. Bovey EH, Altamirano D (1994) Prospective study of 163 retinal
detachments operated by episcleral technique. Klin Monatsbl
Augenheilkd 204:302–305
25. de German I, Ribon R, Arevalo JF (1994) Scleral buckling surgery
for rhegmatogenous retinal detachment: complications. Arch Soc
Am Oftalmol Optom 24:162–171
Graefes Arch Clin Exp Ophthalmol (2012) 250:963–970
26. Curtin BJ (1985) The Myopias; Basic Science and Clinical
Management. Hagerstown, MD, Harper & Row pp 334
27. Wilkinson CP, Rice TA (1997) Michels Retinal Detachment. St.
Louis. MO, CV Mosby, p 77
28. Ogawa A, Tanaka M (1988) The relationship between refractive
errors and retinal detachment-analysis of 1,116 retinal detachment
cases. Jpn J Ophthalmol 32:310–315
29. Azar-Arevalo O, Arevalo JF (2001) Corneal topography changes
after vitreo-retinal surgery. Ophthalmic Surg Lasers 32:168–172