LACQUER CRACKS FOLLOWING LASER TREATMENT OF CHOROIDAL NEOVASCULARIZATION IN PATHOLOGICAL MYOPIA

Background: Lacquer cracks are breaks in the retinal pigment epithelia l-Bruch's membrane-choriocapillaris complex and are manifestations of pathologic myopia. Progressive posterior segment elongation, uveal scl eral thinning, and retinal pigment epithelial degeneration are thought to create a predisposition for crack formation in these eyes. In turn , choroidal neovascularization (CNV) may develop within the cracks to produce disciform scarring of the macula. This study examined lacquer cracks as a possible consequence of laser photocoagulation of CNV. Met hods: From the files of two retinal referral practices, five patients were located in whom lacquer cracks developed or expanded after laser photocoagulation for macular CNV in pathologic myopia. The mean age of the patients was 54.8 years. Four patients were treated with krypton red laser and one with an argon laser. Laser settings were available f or only one of the patients. Results: after laser photocoagulation, la cquer cracks were noted to expand in one or two directions from the la ser scar between 10 days and 3 months of the treatment. The cracks als o sewed as a pathway for progressive or recurrent neovascularization. Conclusions: Although lacquer cracks occur spontaneously in pathologic myopia, expansion, elongation, or simple development of a crack may o ccur as a result of laser photocoagulation of CNV, The new cracks also serve as a potential risk for recurrent neovascularization. This pote ntial adverse complication should be considered in the management of C NV in pathologic myopia with laser treatment.