Coma-like wavefront artifact induced by a posterior staphyloma and high refractive error

Abstract

which is within the expected age range for RDs locally. We have shown that age is a risk factor for RD after laser refractive surgery. It is known that the vitreous undergoes syneresis between 40 and 60 years of age, and a syneretic vitreous is a prerequisite for the occurrence of posterior vitreous detachment and subsequent RD. It would have been interesting to establish the occurrence of posterior vitreous detachments after laser refractive surgery, but we were unable to do so with the limitations of a retrospective study. With longer axial lengths, the myopic eye has a greater tendency to lattice degeneration and PVD, predisposing to retinal tears and detachments. 7–9 The incidence of RD in myopes has been reported to range from 0.71% to 3.20%, increasing to 6.7% in high myopia. 10–13 The overall mean refractive errors at SNEC are 4.43 G 1.83 D for PRK and 6.37 G 2.80 D for LASIK. The patients who had RD after PRK and LASIK had mean preexisting SE of 8.53 G 2.71 D and 9.02 G 3.33 D, respectively. These results suggest that severity of myopia is a significant risk factor for RD after refractive surgery. Retinal detachments have been reported after laser refractive surgery, and the rates are low in general, ranging from 0.05% to 0.25%. 14–17 Our rate of 0.078% similarly falls within the reported range. It must be noted, however, that these rates depend on the duration of follow-up after the laser procedure and the severity of myopia that was treated. In addition, by analyzing the data of patients who returned to SNEC for management only, we were unable to determine the patients, if any, who received surgery for RD post laser refractive surgery at another hospital. Laser refractive surgery by PRK or LASIK is associated with low incidence of RD development. Retinal detachment is encounteredin the naturalhistory of myopiaand should be consideredan expected event, not entirely consequent to the laser procedure. However, the effect of vacuum suction and acoustic shockwaves of the laser may predispose the older high myopes to a higher risk for PVD and RD. Ophthalmologists who perform refractive surgery need to have a higher index of suspicion for RD when these patients are past 40 years of age and have a higher degree of myopia.