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Anterior uveitis after laser in situ keratomileusis
Enrique Suarez1, Francia Torres, Juan C Vieira
1Centro Medico Docente La Trinidad, Caracas, Venezuela.
Purpose:
To report a case series of anterior uveitis after laser in situ keratomileusis (LASIK) and the incidence of anterior uveitis at a mean of 3 years.
Setting:
Centro Medico Docente La Trinidad and Clinica Oftalmologica Centro Caracas, Caracas, Venezuela.
Methods:
Five refractive surgeons and 18488 eyes that had surgical correction of a mean ametropia of -2.23 diopters (D) (range -10.25 to +4.25 D) participated in the study; 74.3% of the eyes were myopic. Laser in situ keratomileusis was performed in all eyes. Patients were followed for a mean of 36 months (range 6 to 48 months) after LASIK. The clinical charts of patients who developed uveitis after LASIK were reviewed. The mean preoperative intraocular pressure (IOP) was 15.2 mm Hg (range 12 to 19 mm Hg). The mean corneal ablation depth was 37.47 micro m (range 12 to 98 micro m). In the immediate postoperative period, all patients received a combination of topical dexamethasone and tobramycin.
Results:
Thirty-five eyes (18 patients) developed anterior uveitis after LASIK. Signs and symptoms appeared a mean of 20.7 days (range 17 to 28 days) postoperatively and 5.08 days (range 2 to 8 days) after withdrawal of topical steroid and antibiotic agents. Eyes that developed LASIK-related uveitis had a mean preoperative spherical equivalent of -2.32 D (range -7.00 to +4.25 D). Intraocular pressure dropped to a mean of 8.0 mm Hg (range 4 to 12 mm Hg) at the onset of uveitis (P <.0001). The LASIK-related anterior uveitis resolved and IOP returned to baseline after a mean of 3 days on topical steroid and cycloplegic agents. Laboratory and immunology (including human leukocyte antigen-B27) tests were negative in 15 of 18 patients (83.33%). The incidence of uveitis after LASIK was 0.18%.
Conclusions:
Anterior uveitis after LASIK is infrequent. It may be due to uveal trauma during surgery with disruption of normal anterior-chamber-associated immune deviation, decreased antiinflammatory cytokines, and increased proinflammatory cytokines. Further studies are needed to investigate the mechanisms of this association.