Photocoagulation recommended for retinal breaks before LASIK

Prophylactic argon laser photocoagulation should be used in myopic patients with retinal tears or breaks before those patients undergo LASIK, a study suggests. The authors contend that repairing the breaks preoperatively can protect against the development of rhegmatogeneous retinal detachments after surgery.

Shih-Chin Lin MD, and Sung-Huei Tseng, MD, performed fundus examinations with indirect ophthalmoscopy in 1,931 eyes of 1,006 patients requesting LASIK to determine the presence or absence of retinal breaks.

Retinal breaks were identified in 39 eyes of 32 patients. Although the breaks were asymptomatic, prophylactic argon laser photocoagulation was performed to seal them. Of the retinal breaks, 24 were found in right eyes and 15 in left eyes. Twenty-one were identified as atrophic holes and 18 as flap tears.

Patients underwent LASIK from 3 to 6 days after undergoing photocoagulation. At 19 months postoperatively, none of the patients had rhegmatogeneous retinal detachments or new retinal breaks. One patient who had previously undergone argon photocoagulation for a peripheral retina flap tear before enrollment in the study was found to have an enlargement of the flap tear 3 months after LASIK. She received an argon laser re-treatment of the enlarged tear. No progression of the retinal tear or retinal detachment was noted at follow-up. One patient without retinal break sustained ocular trauma 19 months after LASIK, resulting in a rhegmatogenous retinal detachment.

The study is published in the November/December issue of the Journal of Refractive Surgery.