Abstract
Purpose :
The flap creation in Laser-assisted in situ keratomileuses (LASIK) is associated with an IOP of >100 mm Hg. We have encountered a subset of patients who have presented with an acquired pit on the optic nerve (APON), RNFL loss, HVF defects, and subjective vision changes after undergoing LASIK. We performed a retrospective review of 5 patients with APON after LASIK looking at risk factors and progression in relation to structural findings on OCT RNFL and OCT of the Optic Nerve Head as well as visual field defects on HVF. We feel the acute IOP increase during LASIK flap creation may potentiate lamina cribrosa failure in these patients leading to structural and functional damage.
Methods :
The medical records of these 5 patients were examined focusing on structural changes in the ONH (slit lamp ophthalmoscopy and OCT with high density scans overlying the nerve head), OCT RNFL, and field defects on HVF. The ages, risk factors, and progression after the first presentation were also included in the analysis.
Results :
In all 5 cases, there is significant thinning (compared to normative data) corresponding to the APON, additionally, the VHF of all of the patients shows significant field depression in the anatomically correspondent location to the APON. Upon review of progression analysis, the VHF and OCT show minimal to no progression after the initial findings. All patients have been managed medically from the time of presentation. OCT of the optic nerve head demonstrates lamina cribrosa defects associated with the APON. Three of the five patients had a family history of glaucoma age, the age of the patients varied between 43 and 78.
Conclusions :
Transiently increased IOP to >100 mmHg during application of LASIK may induce deformations in areas of focal lamina cribrosa defects, leading to axonal damage and loss of optic nerve tissue manifesting as an APON. Given the lack of long-term progression, we feel the visual field defects and RNFL loss seen in our patients are indicative of an acute insult to the nerve versus a typical slowly progressive course. We feel it is important to be aware of this potential complication after LASIK surgery in a subset of patients.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.