Laser in situ keratomileusis-induced optic neuropathy

Ophthalmology. 2001 Apr;108(4):660-5. doi: 10.1016/s0161-6420(00)00577-7.


Objective: To report a case of bilateral optic neuropathy after bilateral laser-assisted in situ keratomileusis (LASIK) surgery.

Design: Observational case report.

Methods: Complete eye examination with detailed evaluation of the optic nerve, detailed medical history, stereo disc photographs, GDx Nerve Fiber Analyzer 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 vision, relative afferent pupillary defect, increased cupping of the optic nerve with focal neuroretinal rim defects, decreased nerve fiber layer thickness, and nerve fiber bundle-type visual field defects. The subject had no other risk factors for optic neuropathy. No other cause of neuropathy was identified.

Conclusions: Optic neuropathy is a potential vision-threatening complication of LASIK surgery. This complication may be due to barotrauma or ischemia related to extreme elevation of intraocular pressure by the suction ring. Careful examination of the optic nerve before and after LASIK surgery is warranted.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Humans
  • Keratomileusis, Laser In Situ / adverse effects*
  • Male
  • Myopia / surgery
  • Nerve Fibers / pathology
  • Optic Nerve / pathology
  • Optic Nerve Diseases / diagnosis
  • Optic Nerve Diseases / etiology*
  • Pupil Disorders / diagnosis
  • Pupil Disorders / etiology
  • Retinal Ganglion Cells / pathology
  • Vision Disorders / diagnosis
  • Vision Disorders / etiology
  • Visual Acuity
  • Visual Field Tests
  • Visual Fields