Objective: To report a case of bilateral optic neuropathy after bilateral l
aser-assisted in situ keratomileusis (LASIK) surgery.
Design: Observational case report.
Methods: Complete eye examination with detailed evaluation of the optic ner
ve, detailed medical history, stereo disc photographs, GDx Nerve Fiber Anal
yzer testing, Humphrey 24-2 SITA visual field testing, diurnal intraocular
pressure measurement, serologic evaluation, and magnetic resonance imaging
of the brain and orbits.
Main Outcome Measures: Optic nerve status, visual field status, and visual
acuity.
Results: A subject with previously healthy optic nerves had bilateral optic
neuropathy develop after LASIK surgery. This neuropathy manifested with a
subjective decrease in visual field, normal visual acuity, normal color vis
ion, relative afferent pupillary defect, increased cupping of the optic ner
ve with focal neuroretinal rim defects, decreased nerve fiber layer thickne
ss, and nerve fiber bundle-type visual field defects. The subject had no ot
her risk factors for optic neuropathy. No other cause of neuropathy was ide
ntified.
Conclusions: Optic neuropathy is a potential vision-threatening complicatio
n of LASIK surgery. This complication may be due to barotrauma or ischemia
related to extreme elevation of intraocular pressure by the suction ring. C
areful examination of the optic nerve before and after LASIK surgery is war
ranted. (C) 2001 by the American Academy of Ophthalmology.