Impact and Permanence of LASIK-induced Structural Changes in the Cornea on Pneumotonometric Measurements: Contributions of Flap Cutting and Stromal Ablation

Abstract

To determine the factors that lead to changes in intraocular pressure (IOP) measurements after laser-assisted in situ keratomileusis (LASIK) and their long-term stability. Five hundred twenty-two myopic eyes and 296 hyperopic eyes were enrolled in the study. Pneumotonometry was used to measure IOP once in the preoperative stage and twice in the postoperative stage-1 month after the operation and 1 year later. Ultrasonic pachymetry was used to determine preoperative and intraoperative corneal thicknesses and axial length of the eye, whereas optical pachymetry was used in the preoperative stage and 1 month after surgery. Corneal topography was used to determine the preoperative and postoperative mean curvature of the anterior surface of the cornea over 3 and 5-mm diameter regions. Comparative statistical analysis of the retrospective data series was performed. A highly significant reduction of IOP readings is found after LASIK for both myopic and hyperopic eyes. The reduction is stable 1 year after LASIK. In the case of myopic eyes, the reduction has a highly significant linear correlation with the amount of tissue ablated in the central region of the cornea. Pneumotonometric IOP readings after LASIK are reduced, without recovering preoperative values even 1 year after surgery, because of flap cutting and tissue removal in the central region of the cornea. The contribution of flap cutting is estimated to be (1.6+/-0.8) mm Hg, whereas ablation contributes an additional (0.029+/-0.003) mm Hg/microm of removed tissue. This effect should be considered when evaluating the accuracy of IOP measurements in LASIK patients who are at risk for developing glaucoma.