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C. N. Singh, A. Tewari; Vitreoretinal Surgery Following Refractive Surgery. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6057.
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Patient expectations following ophthalmic surgery are rising with the popularity of refractive surgery. Many patients who undergo refractive surgery will need vitreoretinal procedures due to myopic pathology, age-related changes and surgical complications. Vitreoretinal surgeons must be prepared to meet patient expectations by overcoming challenges such as refractive considerations in retinal detachment surgery, operating through LASIK flaps, multifocal IOLs and broken posterior capsules. This study is designed to identify these challenges and describe strategies to minimize surgical complications.
Retrospective review of vitreoretinal surgeries done in patients following refractive surgery. Outcomes analyzed include previous type of refractive surgery, vitreoretinal surgical indication, intraoperative challenges, complications and strategies employed.
Seven cases were identified with vitreoretinal surgical indications of retinal detachment (n = 4), macular pucker (n = 2) and lattice degeneration (n = 1). Refractive surgical procedures included LASIK (n = 2), multifocal IOLs (n = 4) and accommodating IOLs (n = 1). Strategies employed following LASIK to prevent damage to the flap include preoperative documentation of flap anatomy, maintaining low intraoperative IOP, frequent hydration, polyvinyl acetate shields, minimizing globe compression and scraping away from the flap hinge. Altered depth perception was noted when operating through multifocal IOLs. Performing epimacular peeling circumferentially at the border of each optical zone prevented iatrogenic retinal trauma. Air-fluid exchanges cause condensation and can decenter the optic of a premium IOL in the setting of a broken posterior capsule. Strategies in these cases include viscoelastic on the posterior optic, humidifiers and maintaining lower IOP to prevent the optic from vaulting anteriorly. Considerations in retinal detachment surgery include considering pneumatic retinopexy or small gauge primary vitrectomy to minimize myopic shift and astigmatism. An additional consideration is prophylactic laser or cryopexy of myopic retinal pathology prior to refractive surgery.
Proper preoperative planning and surgical technique can minimize complications and in patients undergoing vitreoretinal surgery following refractive surgery.
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