The Clinical Manifestation of Unilateral Acute Hydrops after Bilateral Laser In Situ Keratomileusis (LASIK)

PURPOSE: To report a case of a patient who underwent penetrating keratoplasty due to acute hydrops six years after undergoing a bilateral LASIK procedure. METHODS: A 19-year old male patient with -2.75 diopter myopia received a bilateral LASIK operation at a local clinic. Forty-seven months later, -2.00 cyl axis 130o astigmatism was induced in his left eye and additional surgery was performed to correct the LASIK-induced astigmatism. The patient was referred to our hospital 16 months after the secondary operation due to reduced visual acuity in his left eye. He was diagnosed with keratectasia and acute hydrops, and penetrating keratoplasty was performed. RESULTS: The retrospective analysis of the corneal topography prior to the LASIK surgery revealed that the inferior minus superior(I-S) value was 1.25 in the right eye and 1.3 in the left eye. At the time of the first evaluation at out hospital, a slit lamp examination showed an approximate 8 x 7.5mm sized area filled with aqueous humor between the corneal flap and residual stroma, and Descemet's membrane rupture was observed. Furthermore, the histopathological section of the patient's cornea confirmed keratocytes with myxoid degeneration and edematous change. CONCLUSIONS: In young patient, particularly those with suspicious asymptomatic keratoconus, LASIK and further enhancement surgery afterwards should be considered and approached in a cautious and deliberate manner.

A Case of Steroid Treatment on Haze after LASIK Retreatment in eye with previous PRK

PURPOSE: A corneal haze after LASIK retreatment in eye with previous PRK has not been reported in Korea. We experienced a case of myopic regression and haze after LASIK retreatment and treated it with fortified steroid eye solution. Herein we will present it. METHODS: A 38-year-old woman underwent the PRK for the correction of myopia in 1994 and the bilateral LASIK retreatment of myopic regression in January 2000. One year later, the left eye showed myopic regression and severe corneal haze but right eye was nearly emmetropia. PredForte(R) was dropped 4 times daily for 3 months, tapered, substituted with Flumetholon(R) for the next 3 months. We observed for 6 months. RESULTS: Three months later, refraction became nearly emmetropic and uncorrected visual acuity was 0.6. Corneal haze, central keratometric and pachymetric value were much decreased. It remained stable for 6 months.

The Effect of Corticosteroids on Myopic Regression after Laser in Situ Keratomileusis

PURPOSE: This study was to evaluate the effect of topical steroid treatment on eyes that showed myopic regression after LASIK. METHODS: A total of 26 patients (33 eyes) who showed myopic regression more than 1.00 diopter(D) confirmed by topography and pachymeter, were prospectively treated with 1% topical prednisolone acetate. Manifest refraction, Snellen uncorrected visual acuity and intraocular pressure(IOP) were measured before and after treatment. Topical steroids were administered every 2 hours for 3 days and 4 times a day for 11 days. Then the treatments were tapered in the eyes that showed over +0.50 D reversal of myopic regression. But it was immediately stopped in those eyes that showed no improvement or IOP increase. Pachymeter was taken in the improved group 4 weeks after the treatment. RESULTS: Fifteen eyes (45.5 %) showed over +0.50 D reversal of myopic regression(mean +/- SD +1.21 +/- 0.74 D, range: +0.50 ~ +2.75) and the uncorrected visual acuity increased (20/45 before treatment, 20/27 after treatment, p<0.01). The mean corneal thickness decreased (501.9 +/- 18.5 micrometer before treatment, 492.2 +/- 19.2 micrometer after treatment, p<0.01). Refractive effect of the steroid treatment remained stable with four of the eight eyes that could be followed up over six months. IOP was elevated in 3 eyes, but readily normalized with pressure-lowering agent. CONCLUSIONS: Topical steroid treatment for myopic regression after LASIK is partially effective and safe. It is recommendable to use topical steroid prior to performing surgical retreatment.