Laser in situ keratomileusis-induced optic neuropathy

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.