Korean J Ophthalmol.  2014 Jun;28(3):268-271. 10.3341/kjo.2014.28.3.268.

Bilateral Macular Hole Following Myopic Photorefractive Keratectomy

• Shoeibi N
• Jabbarpoor Bonyadi MH
• Abrishami
• Ansari-Astaneh MR

• KMID: 2133327
• DOI: http://doi.org/10.3341/kjo.2014.28.3.268

Abstract

A 42-year-old man was admitted to our clinic complaining of visual distortion in his left eye two months after bilateral myopic photorefractive keratectomy (PRK). Macular optical coherence tomography (OCT) showed a stage II macular hole in the left eye. Simultaneous OCT in the right eye showed vitreous traction and distortion of the outer retina. One month later, the patient underwent vitrectomy for the left eye, and the macular hole was closed. Two months after that, the patient complained of visual distortion in the right eye, and OCT revealed increased traction and accentuated outer retinal distortion indicating a stage IB macular hole. Traction attenuated later without any intervention. The short interval between PRK and hole formation, bilateral involvement, and the moderate refractive error in this case highlight the possible role of PRK in aggravating vitreoretinal interface abnormalities. We recommend the addition of PRK to the list of procedures that may be associated with the formation of a macular hole.

Keyword

Optical coherence tomography; Photorefractive keratectomy; Retinal perforations

MeSH Terms

Adult
Humans
Male
Myopia/*surgery
Photorefractive Keratectomy/*adverse effects
Retina/*pathology
Retinal Perforations/diagnosis/*etiology
Tomography, Optical Coherence
*Visual Acuity

Figure

• 

  Fig. 1 Serial macular optical coherence tomography of the left eye. (A) A full thickness macular hole that developed two months after photorefractive keratectomy, and (B) complete hole closure and restoration of the inner segment/outer segment junction following vitrectomy.

• 

  Fig. 2 Serial macular optical coherence tomography of the right eye. (A) Two months after photorefractive keratectomy (PRK), there is vitreous traction on the macula and mild elevation of the outer retina. (B) Four and one-half months after PRK, the macular traction is increased, and outer retinal distortion indicates a stage IB macular hole. (C) One week later, traction is accentuated, and vision of the right eye is reduced to 20 / 30. (D) Three weeks later, traction is attenuated, and vision is improved to 20 / 25.

Reference

1. Smiddy WE. Atypical presentations of macular holes. Arch Ophthalmol. 1993; 111:626–631.

2. Kokame GT. Early stage of macular hole in a severely myopic eye. Am J Ophthalmol. 1995; 119:240–242.

3. Gass JD. Idiopathic senile macular hole. Its early stages and pathogenesis. Arch Ophthalmol. 1988; 106:629–639.

4. Stulting RD, Carr JD, Thompson KP, et al. Complications of laser in situ keratomileusis for the correction of myopia. Ophthalmology. 1999; 106:13–20.

5. Arevalo JF, Ramirez E, Suarez E, et al. Incidence of vitreoretinal pathologic conditions within 24 months after laser in situ keratomileusis. Ophthalmology. 2000; 107:258–262.

6. Arevalo JF, Ramirez E, Suarez E, et al. Rhegmatogenous retinal detachment after laser-assisted in situ keratomileusis (LASIK) for the correction of myopia. Retina. 2000; 20:338–341.

7. Luna JD, Reviglio VE, Juarez CP. Bilateral macular hemorrhage after laser in situ keratomileusis. Graefes Arch Clin Exp Ophthalmol. 1999; 237:611–613.

8. Chan CK, Lawrence FC. Macular hole after laser in situ keratomileusis and photorefractive keratectomy. Am J Ophthalmol. 2001; 131:666–667.

9. Ruiz-Moreno JM, Artola A, Perez-Santonja JJ, Alio JL. Macular hole in a myopic eye after laser in situ keratomileusis. J Refract Surg. 2002; 18:746–749.

10. Arevalo JF, Rodriguez FJ, Rosales-Meneses JL, et al. Vitreoretinal surgery for macular hole after laser assisted in situ keratomileusis for the correction of myopia. Br J Ophthalmol. 2005; 89:1423–1426.

11. Arevalo JF, Mendoza AJ, Velez-Vazquez W, et al. Full-thickness macular hole after LASIK for the correction of myopia. Ophthalmology. 2005; 112:1207–1212.

12. Ruiz-Moreno JM, Perez-Santonja JJ, Alio JL. Retinal detachment in myopic eyes after laser in situ keratomileusis. Am J Ophthalmol. 1999; 128:588–594.