Full Thickness Macular Hole after Laser Assisted in Situ Keratomileusis: A Case Report and Review of the Literature

Abstract

Purpose: While myopia is known to be a risk factor for Macular Hole (MH) formation, there have been no reviews evaluating the association between LASIK procedure and MH development. Our case series and literature review examine the clinical characteristics and visual outcomes of patients who developed MH following LASIK. Methods: A retrospective chart review was completed for two patients who developed MH following LASIK. For the literature review, Ovid/MEDLINE was searched for all patients who developed MH following LASIK. Results: Two patients with history of LASIK procedure presented with unilateral MH. Both patients were only mildly myopic and lacked other risk factors for MH. They both underwent pars plana vitrectomy, Internal Limiting Membrane (ILM) peel with ILM flap draped over and tucked into the macular hole, followed by 20% sulfur hexafluoride tamponade. Both cases had MH closure and improvement in final visual acuity. The literature review included 25 cases and 27 eyes with MH following LASIK. Twenty-four cases were female and myopic, and the mean refraction was -8.64 D. The average duration from LASIK to MH development was 15.3 months. Mean preoperative best corrected visual acuity was Snellen 20/235. Seventy-seven percent (21/27) of eyes underwent vitrectomy, with a MH closure rate of 100% and final visual acuity of Snellen 20/89. Conclusion: Myopia is a known risk factor for MH formation. However, LASIK procedure may introduce an additional increased risk of MH formation in myopic eyes. Thus, although rarely reported, patients considering LASIK should be counselled on this potential risk.