98th Annual Meeting DOG 2000

P 739

Expulsive hemorrhage and retinal detachment with proliferative vitreoretinopathy after corneal perforation during LASIK procedure in a high myopic eye

W. F. Schrader, B. A. M. Lege, A. Mutsch

Background: A case with an expulsive bleeding after corneal perforation due to LASIK is presented. One has to be aware of this complication especially after repeated LASIK procedures.

Case report: A 39 year old woman.had high myopia of 33,5 dpt in both eyes. One eye was blind due to retinal detachment with PVR.The other eye had a best corrected visual acuity of 20/50. She received LASIK in her second eye elsewhere and developed an unstable refraction and a irregular astigmatism. Corneal topography revealed refraction differences in the visual axis of 60 dpt. Four additional LASIK procedures were performed to reduce this unstable astigmatism to 10 dpt. Immediately after the fifth procedure an intraocular bleeding occurred. Visual acuity was light perception only. Three weeks after this event the patient visited our department. We found a beginning corneal staining after prolonged anterior chamber hemorrhage. A paracentral red spot within the posterior part of the cornea developed as a corneal perforation only covered by the corneal flap. Sonography revealed high choroidal hemorrhages and a PVR detachment in this only eye. Several pars plana vitrectomies had to be carried out to reach anatomic stabilization again. However the eye remained legally blind.

Conclusion: LASIK is recommended for eyes <12 dpt only. In higher myopic eyes one has to expect not only an unstable refraction but also a corneal perforation which may cause a vision threatening complication like a prolonged expulsive hemorrhage.

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