DETACHMENT OF THE POSTERIOR HYALOID MEMBRANE AFTER LASIK

To study changes in the vitreoretinal interface after LASIK in patients with peripheral vitreochorioretinal dystrophies.

In the eye clinic "SIHAT KO`Z" we studied 254 patients (360 eyes) with myopic refraction and peripheral vitreochorioretinal dystrophies. In the main group, there were 168 patients (248 eyes) who underwent LASIK operations with the formation of a flap using microkeratoms. And as a control group, we studied patients who underwent operations using the method of transepithelial photorefractive keratectomy. According to the type of PVRD, the patients were distributed as follows: in 39% of cases, there was lattice dystrophy, in 38% of cases, valvular retinal breaks, and in 23%, dystrophy of the "cochlea mark" type. It should be noted that most of the dystrophic changes were accompanied by tractions and bands.

In addition to standard research methods for keratorefractive surgery, we used: ultrasound research methods (B-scan), A-scan before and during exposure to the vacuum ring and spectral optical coherence tomography of the retinal zone with peripheral vitreochorioretinal dystrophies. Restrictive laser coagulation of the retina in PVRD was performed using an Easyret 577 nm laser unit. Operations were performed on excimer laser units "VISX Star S4 IR™" and "TENEO-317". Corneal flaps were formed by microkeratoms "Amadeus II" and "MORIA One-Use Plus".

After analyzing the changes in the vitreoretinal interface after LASIK in patients with PVRD, we found detachment of the BM in 33% of cases, increased traction in the PVRD zone in 15% of cases, and the formation of new retinal breaks in 2% of cases. Also, local retinal detachment was detected in 3 eyes, subtotal retinal detachment in one eye, which was 0.8%. Also in the study, we analyzed the complaints of patients after operations within 1 month. It was found that in the group of patients after the LASIK operation, complaints associated with the detachment of BMS became more frequent: 30% complained of the appearance of "sparks or lightning" before the eyes, and 24% of the appearance or increase in the number of floating opacities, and only 46% did not show any complaints, against 88% of patients in the control group.

1. Microkeratome can affect the architectonics of the eyeball in the form of an anterior displacement of the lens along with the anterior hyaloid membrane, which will accelerate the detachment of the vitreous body and / or the posterior hyaloid membrane, which in turn can increase the traction component in the posterior pole of the eye.

2. This phenomenon can explain the complications after LASIK associated with traction of the vitreous and retina, which can lead to retinal tears up to rhegmatogenous retinal detachment.

3. When possible, the use of the TransEpi PRK method in patients with peripheral vitreochorioretinal dystrophies will minimize the risk of vitreoretinal complications.