Bilateral retinal hemorrhages following automated lamellar keratoplasty

We describe a case of bilateral multifocal retinal hemorrhages after receiving automated lamellar keratoplasty (ALK) surgery in a 32-year-old male with extremly myopic eyes. Before surgery, there was no retinal hemorrhage in routine fundus examination. This patient visited our clinic and complained of decreased vision in both eyes 2 weeks after the ALK surgery. Upon examination, his best-corrected visual acuity (BCVA) was 0.6 with -8.5-1.5 x 100(0) in the right eye and 0.9 with -4.0-2.50 x 90(0) in the left eye. Fundus examination revealed scattered multiple round focal retinal hemorrhages in both eyes. No evidence of choroidal neovascularization was noted. The retinal hemorrhages resolved 10 weeks later. The BCVA recovered to 1.0 in the right eye and 0.9 in the left eye. This case highlights the relationship between the postoperative bilateral posterior pole hemorrhages and the automated lamellar keratoplasty surgery, in which a microkeratome was used to create a corneal flap and keratectomy. Patients should be informed of this rare complication before surgery.