Choroidal neovascularization following laser in situ keratomileusis for high myopia: a case series
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ORIGINAL PAPER
Choroidal neovascularization following laser in situ keratomileusis for high myopia: a case series Hui Yee Neo • Kumari Neelam • Chee Chew Yip Hui Min Quah • Kah-Guan Au Eong
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Received: 10 April 2011 / Accepted: 27 August 2012 / Published online: 18 October 2012 Ó Springer Science+Business Media B.V. 2012
Abstract To report three patients who developed unilateral choroidal neovascularization (CNV) following laser in situ keratomileusis (LASIK) for high myopia. Retrospective chart reviews of three highly myopic patients who developed CNV following LASIK and who attended a tertiary care private practice were conducted. The clinical presentation of the patients was analyzed. All patients were treated with a combination of intravitreal ranibizumab and photodynamic therapy with verteporfin. Main outcome measures were clinical fundus appearance and best-corrected visual acuity (BCVA) after treatment. Two females and one male with a mean age of 34 ± 2.8 years underwent LASIK for high myopia in both eyes. The mean spherical equivalent was -11.42 diopters (D) (range -6.75 to -20.00). The mean time interval between LASIK and the appearance of symptoms was 9.3 ± 8.5 weeks. One patient developed an extrafoveal CNV at the edge of a laser photocoagulation scar, one developed a subfoveal CNV and the third patient developed a juxtafoveal H. Y. Neo K. Neelam C. C. Yip Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore, Singapore H. Y. Neo C. C. Yip Eye Clinic, Jurong Medical Centre, Singapore, Singapore H. M. Quah K.-G. Au Eong (&) Singapore International Eye Cataract Retina Centre, 3 Mount Elizabeth #07-04, Mt Elizabeth Medical Centre, Singapore 228510, Singapore e-mail: [email protected]
CNV. The mean BCVA at the time of CNV presentation was 0.44 logMAR (range 0.10–0.70 logMAR). Following treatment, the mean BCVA improved to 0.17 logMAR with complete resolution of CNV in two patients. CNV is a rare but potentially blinding complication following LASIK. Short-term good visual outcome can be achieved with timely intervention with current treatment modalities. Keywords Choroidal neovascularization LASIK High myopia Photodynamic therapy VEGF inhibitors
Introduction Laser in situ keratomileusis (LASIK) is a well-established surgical treatment of ametropias [1]. It typically involves the use of a microkeratome to create a thin corneal flap followed by photoablation of the corneal stroma with excimer laser and repositioning of the corneal flap [2]. Currently, approximately 1.5 million LASIK surgeries are performed annually worldwide [3]. LASIK has been reported to be safe and efficacious for correcting low to high myopia; however, it has been associated with a number of anterior segment complications [4, 5]. Choroidal neovascularization (CNV), a potentially blinding posterior segment complication, is much rarer. To date, only 28 eyes of 27 patients with CNV following LASIK for myopia have been reported in the literature (Table 1) [6–12].
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