Abstract
As laser refractive surgeries (LRS) have been widely performed to correct myopia, ophthalmologists easily encounter patients with glaucoma who have a history of LRS. It is well known that intraocular pressure (IOP) in eyes with glaucoma is not accurate when measured using Goldmann applanation tonometry. However, risk factors for glaucoma progression, particularly those associated with measured IOP, have rarely been studied. We analysed data for 40 patients with a history of LRS and 50 age-matched patients without a history of LRS. Structural progression was defined as significant changes in thickness in the peripapillary retinal nerve fibre layer as identified using optical coherence tomography event-based guided progression analysis. Risk factors were determined via Cox regression analysis. Disc haemorrhage (DH) was associated with glaucoma progression in both the non-LRS group and LRS group (hazard ratio (HR): 4.650, p = 0.012 and HR: 8.666, p = 0.019, respectively). However, IOP fluctuation was associated with glaucoma progression only in the LRS group (HR: 1.452, p = 0.023). Our results show that DH was a significant sign of progression in myopic glaucoma eyes. When treating patients with myopia and glaucoma, IOP fluctuation should be monitored more carefully, even if IOP seems to be well controlled.
Highlights
Laser refractive surgeries (LRSs), such as photorefractive keratectomy, laser in situ keratomileusis (LASIK), and laser in situ epithelial keratomileusis (LASEK), are widely performed to correct myopia
LRS changes the central corneal thickness (CCT) and corneal curvature, which affect intraocular pressure (IOP) measured via Goldmann applanation tonometry (GAT), [8,9] resulting in erroneous IOP measurements
40 eyes had a history of LRS, and 50 age-matched eyes had no history of LRS
Summary
Laser refractive surgeries (LRSs), such as photorefractive keratectomy, laser in situ keratomileusis (LASIK), and laser in situ epithelial keratomileusis (LASEK), are widely performed to correct myopia. Acute increases in intraocular pressure (IOP) can damage the optic nerve during surgical procedures [3], and studies have reported that topical steroid use can cause postoperative increases in IOP [4,5] Another concern is the reliability of IOP measurements after LRS. LRS changes the central corneal thickness (CCT) and corneal curvature, which affect IOP measured via Goldmann applanation tonometry (GAT), [8,9] resulting in erroneous IOP measurements Because of these inaccurate IOP measurements, glaucoma progression may be more common in eyes with a history of LRS than in those without a history of LRS, and IOP management in glaucomatous eyes with a history of LRS may require further investigation
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