Incidence of Retinal Lesions before and after Refractive Surgery and Preoperative Prophylactic Laser Treatment

Min Kyo Kim; Hoon Lee; Hyung Keun Lee; Kyoung Yul Seo; Eung Kweon Kim; Tae Im Kim

doi:10.3341/jkos.2015.56.11.1671

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Kim, Lee, Lee, Seo, Kim, and Kim: Incidence of Retinal Lesions before and after Refractive Surgery and Preoperative Prophylactic Laser Treatment

Original Article

J Korean Ophthalmol Soc 2015;56(11):1671-1676.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.11.1671

Incidence of Retinal Lesions before and after Refractive Surgery and Preoperative Prophylactic Laser Treatment

Min Kyo Kim, M.D^1,², Hoon Lee, M.D¹, Hyung Keun Lee, M.D¹, Kyoung Yul Seo, M.D, PhD¹, Eung Kweon Kim, M.D, PhD¹, Tae Im Kim, M.D, PhD^1,

¹The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Siloam Eye Hospital, Seoul, Korea

Address reprint requests to Tae Im Kim, MD, PhD Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541 E-mail: taeimkim@gmail.com

‗ This study was presented as a narration at the 111th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 13 March 20155 July 2015 Accepted 4 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We investigated the incidence of retinal lesions before and after surgery and the percentage of preoperative prophy-lactic laser treatment in patients who underwent corneal refractive surgery or phakic intraocular lens implantation (pIOLi).

Methods

The medical records of patients who underwent refractive surgery from January 2005 to June 2013 were reviewed retrospectively. We investigated the incidence and type of retinal lesions identified during the preoperative examination. Additionally, the percentage of preoperative prophylactic laser treatment and the incidence of postoperative newly developed retinal lesions were analyzed.

Results

A total of 894 eyes of 466 subjects (laser in situ keratomileusis [LASIK] 225 eyes, 117 subjects; laser-assisted sub-epithelial keratectomy [LASEK] or photorefractive keratectomy [PRK] 450 eyes, 231 subjects; pIOLi 219 eyes, 121 subjects) were enrolled in the present study. Retinal lesions were found in 268 eyes (29.98%) and of those, 144 eyes (16.11%) received prophylactic laser treatment. Postoperative newly developed retinal lesions were detected in 8 cases (LASEK or PRK, 5 cases; pIOLi, 3 cases) during the follow-up period. There was a significant correlation between preoperative spherical equivalent and the presence of retinal lesions.

Conclusions

The patient population of refractive surgery is largely myopic and thus particularly vulnerable to retinal lesions. Additionally, a considerable number of patients required preoperative prophylactic laser treatment. Therefore, both surgeons and patients should be aware of the risks of developing postoperative retinal lesions.

Keywords: Myopia, Phakic intraocular lens implantation, Prophylactic laser treatment, Refractive surgery, Retinal lesion

References

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Figure 1.

Changes in prevalence of pre- and postoperative reti-nal lesions according to spherical equivalent. ^* p < 0.05 com-pared with previous subgroup, independent t-test.

Table 1.

Characteristics of patients based on different type of surgery

	LASIK	LASEK or PRK	pIOLi	Total	p-value
Eyes (subjects, n)	225 (117)	450 (231)	219 (121)	894 (466)
Age (years)	26.76 ± 6.16	26.92 ± 6.30	28.32 ± 6.16	27.24 ± 6.25	0.09^*
Men:women	34:82	71:158	37:84	142:324	0.95^†
SE (D)	-5.49 ± 2.17	-5.18 ± 1.96	-10.78 ± 3.33	-6.61 ± 3.42	<0.05^*
ACD (mm)	3.43 ± 0.36	3.14 ± 0.27	3.47 ± 0.37	3.29 ± 0.36	<0.05^*
Retinal lesions (n, %)	40 (17.78)	129 (28.67)	99 (45.21)	268 (29.98)	<0.05^†

Values are presented as mean ± SD unless otherwise indicated.

LASIK = laser in situ keratomileusis; LASEK = laser-assisted subepithelial keratectomy; PRK = photorefractive keratectomy; pIOLi = phakic intraocular lens implantation; SE = spherical equivalent; ACD = anterior chamber depth.

^* One-way ANOVA

^* Chi-square test.

Table 2.

The correlation between characteristics of patients and presence of pre- and postoperative retinal lesions

	Presence of pre- and postoperative retinal lesions
	OR	95% CI	p-value^*
Age	1.01	0.98-1.03	0.54
Sex
Men vs. women	0.92	0.66-1.27	0.61
Type of surgery
Corneal refractive surgery vs. pIOLi	0.97	0.60-1.56	0.89
SE	0.83	0.78-0.88	<0.05
ACD	0.79	0.51-1.23	0.31

OR = odds ratio; CI = confidence interval; pIOLi = phakic intraocular lens implantation; SE = spherical equivalent; ACD = anterior chamber depth.

^* Logistic regression.

Table 3.

Type of preoperative retinal lesions

Types of lesion (n)	No. of eyes
LASIK	LASEK or PRK	pIOLi	Total
Lattice degeneration	28	87	57	172
Retinal thinning	3	12	5	20
Lattice with retinal hole	3	7	18	28
PVD	1	1	2
Retinal hole	1	4	8	13
Retinal tear	4	4	8
Other retinal lesions	4^*	14^†	7^‡	25
Total	40	129	99	268

^* Cystic retinal tuft, atrophic scar, previous laser scar

^† Cystic retinal tuft, myopic degeneration, vitreous opacity, previous scleral encircling, previous laser scar

^‡ Cystic retinal tuft, atrophic scar, disc coloboma, epiretinal membrane, congenital retinal pigment epithelial hypertrophy, previous scleral encircling, previous laser scar.

Table 4.

The number of eyes with preoperative prophylactic laser treatment and the ratio of that to the number of retinal lesions

Types of lesion (n)	No. of eyes (%)
	LASIK	LASEK or PRK	pIOLi	Total
Lattice degeneration	23	36	34	93 (54.07)
Retinal thinning	1	1	1	3 (15)
Lattice with retinal hole	3	6	17	26 (92.86)
PVD	0	0	0	0
Retinal hole	1	3	8	12 (92.31)
Retinal tear	0	4	4	8 (100)
Other retinal lesions	1^*	1^†	0	2 (8)
Total	29 (72.5)	52 (40.31)	64 (64.64)	144 (53.73)

^* Atrophic scar

^† Cystic retinal tuft.

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