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M.G. Parker, Q. Farjo; Development of Chorioretinal Folds Following Laser in situ Keratomileusis (LASIK) for Hyperopia . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4370.
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Purpose: To describe the first reported case of chorioretinal folds after laser in situ Keratomileusus (LASIK) Methods: A 47 year old male developed bilateral chorioretinal folds following uncomplicated LASIK for hyperopia. Results: After a complete examination by the retina service, he was diagnosed with bilateral idiopathic/hyperopic chorioretinal folds. He has been followed for ten months and has persistent choroidal folds but his best corrected visual acuity remains stable; OD 20/25 and OS 20/20 Conclusions: Chorioretinal folds have been associated with numerous conditions including: orbital tumors, posterior scleritis, and hyperopia, etc. They have also been reported following surgical procedures such as trabeculectomy and pars plana vitrectomy. To our knowledge this is the first reported case of chorioretinal folds diagnosed in the post–operative period following LASIK. A 47 year–old male underwent bilateral simultaneious hyperopic LASIK using a Hansatome and Technolas 217 laser. A complete preoperative dilated ophthalmic exam demonstrated normal retinas and stable hyperopic refraction. The patient did have poor BCVA due to anterior basement membrane dystrophy which improved following bilateral diamond burr superficial keratectomy prior to LASIK. Following LASIK, UCVA was 20/20 OU on day #1. However, six months post–LASIK his UCVA OD gradually dropped to 20/100 and OS to 20/40 due to hyperopic regression. Dilated fundus examination did not demonstrate any abnormalities. An uncomplicated enhancement was performed on the right eye 30 weeks after the initial procedure by flap lift. After one month, dilated fundus exam, fluorescenin angiography.and optical coherence tomography demonstrated choroidal folds OU. Axial lengths were found to be OD 21.58mm and OS 22.04mm. Consultation with a retinal specialist was sought who felt the choroidal folds were most consistent with idiopathic/hyperopic folds. Given the possibility that the LASIK procedure may have produced or exacerbated the choroidal folds and the greater likelihood for folds to occur in short eyes, the authors recommend obtaining pre–operative axial length measurements and preforming a careful dilated fundus exam in patients undergoing hyperopic refractive procedures. A discussion should be had with the patient about the possibility of choroidal folds occurring post–operatively in eyes with short axial lengths. Choroidal folds should also be considered in the differential diagnosis of hyperopic regression following refractive surgery. Dilated retinal examination should be performed prior to any enhancement in a patient with hyperopic regression.
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