Knapp C., Mittelviefhaus H.

Universitäts-Augenklinik, Killianstraße 5, 79106 Freiburg

Introduction: Laser in situ Keratomileusis (LASIK) is regarded as a scientifically established and save procedure for myopia up to -10 diopters. We report on a 34 year-old patient with dramatic visual acuity and visual field loss in both eyes after LASIK.
Case: The patient was referred to us in December 2000 because of an unusual, diffuse opacification of the cornea and secondary pressure rise in both eyes after LASIK. LASIK had been performed in both eyes in October 1999. Preoperative refraction was -8,5 -1,75/90° in the right eye and -7,0 -3,50/80° in the left. Intraoperatively corneal erosiones had been seen in both eyes. They were treated with therapeutical contact lenses. Diffuse lamellar keratitis developed in both eyes and was treated with topical steroids. Eye pressure rose to 30 mmg but interstitial keratitis did not improve. After irrigation of the interface and change to non-steroidal antiinflammatory drugs corneal opacifications cleared and eye pressure readings were normal again. In May 2000 uncorrected visual acuity was 20/32 in the right eye and 20/20 in the left eye. In June 2000 vision deteriorated because of severe superficial keratitis, progressing interstitial opacifications and growing bullous changes with normal eye pressure in both eyes. In November 2000 corneal opacification made visulisation of the fundus impossible. Visual acuity was less than 20/200 in both eyes, eye pressure was again up to 30 to 40 mmHg. First seeing the patient in December 2000 we documented severe cupping of the optic nerve head, visual field loss and a for the most part bullous keratopathy with markedly elevated eye pressure. While the corneal opacifications in both eyes cleared after cyclophotokoagulation, visual fields deteriorated to a central remnant of 10 to 15°, even though eye pressure was effectively controlled at 11 mmHg. The cause of this dramatic visual acuity and visual field loss most certainly is a steroid induced secondary glaucoma unrecognised because of the severe keratopathy.
Conclusion: In single cases complications after LASIK might not only lead to inability to drive and work but also leave the patient almost blind. This should be considered when talking to the patient about possible complications.

Copyright © Deutsche Ophthalmologische Gesellschaft, 2001. All rights reserved.

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