Journal of Refractive Surgery

Review Supplemental Data

Does Corneal Refractive Surgery Increase the Risk of Retinal Detachment? A Literature Review and Statistical Analysis

Piotr Kanclerz, MD, PhD; Andrzej Grzybowski, MD, PhD, MBA

Abstract

PURPOSE:

To evaluate the association between corneal refractive surgery and the risk of developing retinal detachment.

METHODS:

PubMed and Web of Science were the main resources used to search the medical literature.

RESULTS:

Presumed mechanisms by which corneal refractive surgery would induce retinal detachment include biomechanical changes caused by a suction ring, excimer laser shock-wave, or the use of a femtosecond laser. However, the reported retinal detachment rates after corneal refractive surgery are similar to those of an unoperated myopic cohort. No differences were found between retinal detachment rates in laser in situ keratomileusis and superficial corneal refractive surgery. The pooled analysis found an overall risk of developing retinal detachment after laser in situ keratomileusis of 0.08% (95% CI: 0.69% to 0.82%). Higher preoperative refractive error, patient age, and male gender were associated with an increased risk of retinal detachment.

CONCLUSIONS:

The current analysis presents no convincing evidence to support the causal relationship between corneal refractive surgery and retinal detachment. Patients at risk of developing retinal detachment should be treated with caution and informed that corneal refractive surgery reduces the refractive error, but does not eliminate the risks related to myopia.

[J Refract Surg. 2019;35(8):517–524.]

Abstract

PURPOSE:

To evaluate the association between corneal refractive surgery and the risk of developing retinal detachment.

METHODS:

PubMed and Web of Science were the main resources used to search the medical literature.

RESULTS:

Presumed mechanisms by which corneal refractive surgery would induce retinal detachment include biomechanical changes caused by a suction ring, excimer laser shock-wave, or the use of a femtosecond laser. However, the reported retinal detachment rates after corneal refractive surgery are similar to those of an unoperated myopic cohort. No differences were found between retinal detachment rates in laser in situ keratomileusis and superficial corneal refractive surgery. The pooled analysis found an overall risk of developing retinal detachment after laser in situ keratomileusis of 0.08% (95% CI: 0.69% to 0.82%). Higher preoperative refractive error, patient age, and male gender were associated with an increased risk of retinal detachment.

CONCLUSIONS:

The current analysis presents no convincing evidence to support the causal relationship between corneal refractive surgery and retinal detachment. Patients at risk of developing retinal detachment should be treated with caution and informed that corneal refractive surgery reduces the refractive error, but does not eliminate the risks related to myopia.

[J Refract Surg. 2019;35(8):517–524.]

Corneal refractive surgery is an elective procedure presenting a low risk of complications. Commonly, eyes with perfect corrected visual acuity are treated and so sight-threatening complications are a major concern. Although anatomical and refractive complications represent the majority of problems after surgery, retinal complications are potentially sight-threatening.1 Moreover, refractive surgery procedures are performed most commonly in myopic patients, and myopia is known as a relevant risk factor for rhegmatogenous retinal detachment.2 High volumes of corneal refractive surgery performed worldwide necessitate the awareness of potential complications and side effects of surgery.3

Cases of bilateral retinal detachment after laser in situ keratomileusis (LASIK) have been reported in the medical literature.4–7 In one study, retinal detachment developed immediately after corneal refractive surgery, which clearly suggested a cause/effect relationship.8 The aim of this review was to evaluate the association between corneal refractive surgery and the risk of developing retinal detachment.

Methods

Literature Search

The PubMed and Web of Science databases were the main resources used to conduct the medical literature search. An extensive search was performed to identify relevant articles concerning corneal refractive surgery and the risk for retinal detachment development up to December 31, 2018. The following key words were used in various combinations: retinal detachment, retinal tear, lattice degeneration, posterior segment complications, posterior vitreous detachment, corneal refractive surgery, excimer laser, femtosecond laser, laser in situ keratomileusis, LASIK, laser epithelial keratomileusis, laser epithelial keratomileusis (LASEK), photorefractive keratectomy (PRK), small incision lenticule extraction, and small incision lenticule extraction (SMILE). Of the studies retrieved by this method, we reviewed all publications in English and those having English abstracts. The reference lists of the analyzed articles were also considered as a potential source of information. We included original studies that described the incidence, etiopathogenesis, and retinal detachment risks in eyes undergoing corneal refractive surgery. We excluded case reports and studies that did not refer to biomechanical changes induced in the eye by corneal refractive surgery. Emphasis was placed on articles published since the review by Loewenstein et al.,9 but we included earlier articles that provided a more comprehensive understanding of retinal detachment risk. The review articles assessing retinal complications after corneal refractive surgery were considered10,11; however, our study was focused solely on the retinal detachment risk. Studies were critically reviewed to create an overview and guidance for further search. No attempts to discover unpublished data were made. The search strategy is presented in detail in Table A (available in the online version of this article).

Search Strategy

Table A:

Search Strategy

Study Selection for the Statistical Analysis

Articles were included in our statistical analysis if they met the following criteria: (1) the study design was a cohort study; (2) the association of the exposure to LASIK with retinal detachment was evaluated; (3) the outcome of interest was development of retinal detachment; and (4) risk and odds ratios or proportions and their corresponding 95% confidence interval (CI) were reported or provided data to calculate them. Studies were excluded from the statistical analysis if they analyzed retinal detachment risk only after superficial procedures. If one identified article reported on the same study population, we selected the results with the longest follow-up available. If more than one surgical technique was applied within the study, only results for the LASIK cohort were included. We evaluated the methods for selecting study participants, various study designs, and criteria for defining exposures and outcomes.

Results

Risk of Retinal Detachment Development After Corneal Refractive Surgery

The search identified 77 unique articles. After removing duplicates and irrelevant studies, 44 articles were included in the review. Table 1 presents the risk of retinal detachment following corneal refractive surgery (after both LASIK and PRK), whereas Table 2 shows only the risk after LASIK. Our statistical analysis encompassed 12 original studies and the results are presented on a forest plot (Figure 1). Most of the studies included in this analysis reported retinal detachment risk in a myopic cohort. However, one study12 also included hyperopic patients who underwent surgery and another did not present information about the preoperative refractive error.13 The postoperative follow-up was at least 12 months in 7 of 12 studies, 1 study reported retinal detachment risk in a 10-year period, and 3 studies did not specify the follow-up period.14 The pooled analysis found an overall risk of developing retinal detachment following LASIK of 0.08% (95% CI: 0.69% to 0.82%).

Large Studies Reporting the Incidence of RD Following Corneal Refractive Surgery

Table 1:

Large Studies Reporting the Incidence of RD Following Corneal Refractive Surgery

Incidence of Retinal Detachment Following LASIK

Table 2:

Incidence of Retinal Detachment Following LASIK

Forest plot of cohort studies that evaluated retinal detachment risk after laser in situ keratomileusis. The effect size (square, with size proportional to weights used) and 95% confidence intervals (CIs) (horizontal lines) is presented for each study. The overall measure revealed by pooled analysis is marked with the center of the diamond, and associated confidence intervals by lateral tips of diamond.

Figure 1.

Forest plot of cohort studies that evaluated retinal detachment risk after laser in situ keratomileusis. The effect size (square, with size proportional to weights used) and 95% confidence intervals (CIs) (horizontal lines) is presented for each study. The overall measure revealed by pooled analysis is marked with the center of the diamond, and associated confidence intervals by lateral tips of diamond.

Mechanisms for Retinal Detachment Development

It is speculated that specific damage caused by corneal refractive surgery in an eye with an underlying predisposition, particularly in myopia, may result in retinal detachment.15 The possible mechanisms by which corneal refractive surgery is believed to produce damage include trauma caused by the suction ring, the shock-wave effect associated with the excimer laser, and a thermic effect.16

Biomechanical Changes Caused by the Suction Ring. Biomechanical stress caused by the suction ring of the microkeratome or femtosecond laser is suggested as the principal causative factor in vitreoretinal pathologies associated with corneal refractive surgery.11 It is known that the intraocular pressure (IOP) generated by placing a manual microkeratome suction ring might reach levels of 150 mm Hg.17 Mostafavi et al.18 showed that application of the suction ring resulted in a shortening of the axial length of porcine eyes ranging from 0.38 to 1.48 mm (mean: 0.67 mm). This change in axial length could generate transverse vector forces at the vitreoretinal interface and provoke posterior vitreous detachment (PVD) and the development of retinal tears or retinal detachment. On the other hand, in an experimental model based on human eyes obtained from an eye bank, the application of the suction ring resulted in increasing the axial length of the eye by approximately 1.125 mm, whereas the anterior chamber depth remained stable.19 In this model, anterior movement of the vitreous base could presumably provoke development of vitreoretinal pathology.20 Finally, in a study by Mirshahi and Kohnen,3 the anterior chamber depth and axial length did not change during microkeratome suction, but a decrease in lens thickness and an increase in vitreous distance was observed. Similarly, such accelerated vitreous detachment could increase traction at the vitreous base.

Arevalo et al.21 suggested that the temporal location of the retinal breaks in patients with retinal detachment might be associated with the location of the microkeratome handle, putting extra pressure on that side of the eye. An example of the intensity of mechanical forces applied within the procedure and affecting the posterior segment of the eye is a report of bilateral macular hemorrhage following LASIK in a patient with high myopia.11

It should be underscored that the biomechanics of the vitreous was assessed by Mazur et al.20 in 69,039 ocular pneumoplethysmography tests. Ocular pneumoplethysmography is non-invasive technique applied to evaluate suspected carotid arterial lesions in patients having concomitant ocular diseases.22 During the procedure, typical vacuum levels reach 300 mm Hg, whereas the IOP might exceed 100 mm Hg. Nevertheless, during the procedure, using B-scan ultrasonography, no motions or disturbances of vitreous structures were detected in myopic patients.20 It should be noted that the rapidity of IOP changes generated by the suction ring is greater than that during pneumoplethysmography, where a progressive IOP decay lasts approximately 30 seconds.23 Yet, the IOP changes related solely to the use of the suction rings could result in mechanical stress on the eye.

Excimer Laser Shock-wave. Pulsed laser ablation of any kind of materials results in the creation of a stress wave at the object's surface that spreads into the bulk.24 The stress wave peak amplitude is greater for large spot diameters and correlates linearly with the applied fluence.25 Spot diameters of 1 to 6.5 mm are used for tissue ablation in currently used lasers. For spot diameters up to 3 mm, the stress wave amplitude significantly decreases with distance from the endothelium, whereas in diameters larger than 3 mm, the peak pressure is localized 6 to 7 mm behind the endothelium.25 The critical volume where the side effects are to be expected is located near the lens–vitreous boundary; however, the negative pressure wave may also reach the retina.

It was speculated that excimer laser shock waves might be an iatrogenic factor generating stress on the posterior segment of the eye.9 This would result mainly in cellular alterations and structural damage to the adjacent collagen layer.9 Particularly, myopic eyes would be predisposed to such pathology because they have extremely fragile structures (ie, the submacular vessels).10 Ozdamar et al.5 suggested a combined mechanism of a sudden increase in IOP exerting mechanical stress on the vitreous along with mechanical stress induced by laser shock waves.

Use of the Femtosecond Laser. In femtosecond laser surgery, slightly less vacuum is necessary for suction cup placement than with manual microkeratomes; however, the time needed to create a flap is significantly longer.11 Nevertheless, strong deformation of the eye during applanation results in IOP elevation up to 90 mm Hg above baseline. The IOP rise during the procedure is higher with curved contact lens interfaces than with a liquid optical immersion interface.26 A macular hemorrhage was reported after femtosecond laser–assisted LASIK without any risk factors for such a pathology.11 Moreover, studies on animals presented that the femtosecond laser itself is potentially capable of causing retinal injuries.27

Factors Influencing the Retinal Detachment Risk After Corneal Refractive Surgery

Presence of Peripheral Retinal Lesions—Should They Be Treated? LASIK does not appear to lead to progressive retinal lesions in asymptomatic patients.28 Moreover, the efficacy of prophylactic treatment in such conditions is doubtful. For example, in a study by Ruiz-Moreno et al.,29 patients with predisposing lesions previously treated with laser photocoagulation had a higher retinal detachment rate compared to the untreated group (0.92% vs 0.15%, respectively). In a study by Chan et al.,30 prophylactic treatment of vitreoretinal pathology such as lattice degeneration or retinal breaks did not guarantee that vitreoretinal complications following LASIK will not occur. In their study, 88.2% of patients who developed retinal detachment had retinal breaks adjacent to lesions found before LASIK, whereas retinal breaks were noted in other quadrants than those found before LASIK in 29.4% of patients. In a survey by Chan et al.,28 a large percentage of eyes with substantial myopia manifested retinal breaks after LASIK, but were comparable with results found in unoperated eyes with high myopia. Some authors have suggested that patients undergoing corneal refractive surgery should receive more aggressive prophylactic retinal therapy.31 Nevertheless, it is not possible to scientifically determine whether peripheral retinal lesions should be treated differently from standard practice simply because a patient is to undergo LASIK. Close postoperative monitoring of patients with high myopia to prevent potential vitreoretinal complications could be suggested.

Furthermore, Sinha et al.32 reported that LASIK for correcting postoperative refractive errors may be performed safely after retinal detachment surgery. In this case, none of the 8 eyes having undergone LASIK had postoperative retinal complications. The only difficulty encountered in these eyes was conjunctival scarring, which influenced the suction of the microkeratome. Thus, the surgery could not be completed in two eyes.

Preoperative Refractive Error. Lee et al.33 reported a greater level of myopia in patients who developed retinal detachment after corneal refractive surgery than in the overall cohort undergoing surgery. Myopic individuals with retinal detachment had a refractive error of −8.84 ± 2.92 D, whereas, in general, myopic patients undergoing corneal refractive surgery had a refractive error of −5.94 ± 2.75 D. Similar results were presented in a study by Faghihi et al.34; the mean refractive error in eyes that developed retinal detachment was −8.60 ± 3.90 D, whereas it was −6.10 ± 3.50 D in the general myopic cohort undergoing corneal refractive surgery (P < .001). It should be highlighted that the general risk for retinal detachment is greater in eyes with a higher refractive error.35 We suggest that when considering corneal refractive surgery in individuals with greater refractive errors, the treatment should be performed with caution. With that, patients should be informed that corneal refractive surgery reduces the refractive error but does not eliminate the risks related to myopia itself.

Older Age. Myopic patients who developed retinal detachment after corneal refractive surgery were significantly older than the general cohort that underwent corneal refractive surgery; the mean age was 46.4 ± 11.2 and 33.41 ± 7.64 years, respectively.33 In another study, patients who developed retinal detachment were 38.2 ± 11.2 years old, whereas the mean patient age of those undergoing corneal refractive surgery was 30.7 ± 8.5 years.34 According to Faghihi et al.,34 the association between age and retinal detachment risk is not strong, with an adjusted odds ratio of 1.08. However, in a general population there is a significant association between age and retinal detachment incidence rates.36 One possible reason is the PVD, because retinal detachment is commonly associated with symptomatic PVD.37 There is a correlation between PVD and presence of horseshoe-shaped tears at the central border of the vitreous base.36

Surgical Approach: PRK, LASIK, and SMILE. The idea that the forces applied by the suction result in a risk of retinal detachment should manifest in the presence of a dissimilarity of retinal detachment rates between LASIK and PRK. Nevertheless, such a difference was never proven, and the differences between procedures were not statistically significant in studies that assessed outcomes of PRK and LASIK.16,33 Notably, within several of the analyzed studies, patients undergoing LASIK had a greater refractive error than those undergoing PRK, which could also be a confounding factor.16,33 Because SMILE is a relatively new technique, no study was found that analyzed the long-term risk of developing retinal detachment after SMILE. Nevertheless, it could be similar to that of studies of other techniques.

PVD. One of the mechanisms by which shock waves, IOP alterations, and biomechanical changes caused by the suction ring could influence the posterior segment is by the development of PVD. An association between microkeratome-assisted LASIK and PVD was reported with an overall incidence of new PVD after LASIK, reaching 9.5% to 21.4% of eyes.3,38 In a study by Luna et al.,39 PVD developed more frequently in eyes with high myopia than in those with low myopia.

Theoretically, because the pressure alterations within the eye are lower in femtosecond laser–assisted LASIK than in manual microkeratome LASIK, the PVD development may also be less common. However, in a study by Osman et al.,40 PVD was detected in 85% of cases (17 eyes) after femtosecond laser–assisted LASIK, whereas only 20% of cases (4 eyes) developed PVD after LASIK performed with a manual microkeratome. The authors concluded that this may be caused by the longer suction time in femtosecond laser–assisted LASIK. In another study, the development of PVD after femtosecond laser–assisted LASIK was reported in 16% of myopic eyes.41 A disadvantage of all of the aforementioned studies is a relatively small sample size.

Other Factors. Faghihi et al.34 noted that although male patients contributed to 39.2% of LASIK patients, 71.4% of the cohort that developed retinal detachment following LASIK were male (adjusted OR was 3.16 for male gender). On the other hand, even males who have not undergone surgery are more susceptible to developing retinal detachment.36,42 For example, in the Dutch Rhegmatogenous Retinal Detachment Study,36 the male-to-female ratio was 1.3:1. It was speculated that this could be attributed to a higher risk of ocular trauma in males than in females. Although PVD is more common in females than in males,43,44 in males, it is more often complicated by the development of retinal tears.37

Discussion

The annual incidence of retinal detachment in various refractive errors and age groups is presented in Table 3. It appears that the reported rates of retinal detachment after corneal refractive surgery are similar or sometimes lower than in an unoperated myopic cohort. Such findings could have the following explanations. First, patients with retinal problems or a family history of retinal detachment may not present for corneal refractive surgery due to fear of retinal complications.45 Second, patients undergoing corneal refractive surgery may have a thorough preoperative examination under cycloplegia, including funduscopy with scleral depression and treatment of predisposing lesions.21

Annual Incidence of Retinal Detachmenta

Table 3:

Annual Incidence of Retinal Detachment

Another issue to consider is that the analyzed studies assessed the risk of retinal detachment in an eye. If patients were counted as the denominator, the complication rate would be nearly twice as high.46 Moreover, in a study by Arevalo et al.,12 3 of 17 patients developed retinal detachment bilaterally. Thus, the likelihood of complications is influenced by factors shared between eyes of a patient.46 Finally, because retinal detachment is treated by vitreoretinal surgeons, the exact retinal detachment rate after corneal refractive surgery reported by refractive surgeons may be lower due to a lack of communication between these specialists.41

Conclusions

The current analysis presents no convincing evidence to support the causal relationship between corneal refractive surgery and retinal detachment development; therefore, retinal detachment is not associated with corneal refractive surgery. Furthermore, this research found no difference between retinal detachment rates in LASIK and superficial corneal refractive surgery. Higher preoperative refractive error, patients' ages, and male gender were associated with an increased risk of developing retinal detachment. These patients should be treated with caution and informed that corneal refractive surgery reduces the refractive error but does not eliminate the risks related to myopia.

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  51. Ruiz-Moreno JM, Artola A, Alió JL. Retinal detachment in myopic eyes after photorefractive keratectomy. J Cataract Refract Surg. 2000;26:340–344. doi:10.1016/S0886-3350(99)00409-5 [CrossRef]
  52. Stulting RD, Doyle Stulting R, Carr JD, et al. Complications of laser in situ keratomileusis for the correction of myopia. Ophthalmology. 1999;106:13–20. doi:10.1016/S0161-6420(99)90000-3 [CrossRef]

Large Studies Reporting the Incidence of RD Following Corneal Refractive Surgery

StudyPopulation (Average SER Range)ProcedureRD Risk—Follow-upConclusion
Arevalo et al., 20121422,792 myopic eyes (−4.81 ± 2.20 D; −1.50 to −10.00 D)LASIK0.05% = 1 year; 0.15% = 5 years; 0.19% = 10 yearsThe risk of RD after LASIK is very low if patients are properly screened and prophylactic treatment is applied
Al-Rashael & Al-Khalafi, 2011476,112 eyesLASIK0.0003% = N/A (RD after an average of 37.6 months; range: 4 months to 10 years)The prevalence of RD after LASIK was low with no causal relationship between LASIK and RD
Qin et al., 20074818,342 myopic eyes (−9.33 D; −6.25 to −14.00 D)LASIK0.033% = 20 months; range: 3 to 18 monthsRD after LASIK for correction of myopia is uncommon, and results of the study suggested no cause-and-effect relationship
Faghihi et al., 20063459,524 myopic eyes (−6.10 ± 3.50 D; −0.75 to −26.50 D)LASIK0.082% = 31.6 months (95% CI : 0.061 to 0.109); 0.032% annually (95% CI: 0.023 to 0.042)LASIK did not appear to be an additional risk factor for RD development; patients who are male, are older. and have high myopia preoperatively may be at increased risk
Lee et al., 2006335,695 eyes (−4.43 ± 1.83 D; −0.25 to −16.88 D)PRK0.07% = minimum 6 months (RD 23.8 ± 22.5 months after PRK/LASIK; range: 3 to 68 months)Laser refractive surgery was associated with low incidence of RD development, presumably due to the natural history of myopia
7,065 eyes (−6.37 ± 2.81; −2.425 to −0.13)LASIK0.084% = minimum 6 months (RD 23.8 ± 22.5 months after PRK/LASIK; range: 3 to 68 months)
Feki et al., 2005168,755 myopic eyes (−7.25 D)PRK0.069% = N/A (RD after an average of 31.7 months after surgery; range: 3 to 84 months)The rate of RD after excimer laser surgery in the analyzed myopic population was equal to or even lower than that estimated with an emmetropic population
14,015 myopic eyes (−8.75 D)LASIK0.064% = N/A (RD after an average of 14 months after surgery [range: 2 to 36 months])
Arevalo et al., 20024938,823 myopic eyes (−6.00 D; −0.75 to −29.00 D)LASIK0.08% = 14 months (range)Final visual acuity in RD may be limited by myopic degeneration, amblyopia, or delayed surgical repair
Arevalo et al., 20012131,739 myopic eyes (−6.01 D; −0.75 to −29.0 D)LASIK0.06% = 36 months (range: 6 to 48 months)RD after LASIK for the correction of myopia is infrequent
Aras et al., 2000504,432 eyes (N/A)LASIK0.022% = N/A (RD after 5.2 ± 2.78 months; range: 2 to 9 months)The study suggests the possible association between RD and LASIK in patients with myopia
Ruiz-Moreno et al., 2000515,936 myopic eyes (−4.71 ± 2.86 D; −1.00 to −14.00 D)PRK0.08% = 38.5 ± 17.4 monthsIn 4 of 5 eyes with RD there was little or no visual loss, but in the group as a whole, there was a significant increase in myopic SER
Arevalo et al., 20001229,916 ametropic eyes (83.2% myopia −6.19; −0.75 to −29.00 D; hyperopia +3.23 D; +1.00 to +6.00 D)LASIK0.047% = 24 months; range: 6 to 36 months; 0.013% = retinal breaks without RDSerious complications after LASIK are infrequent and it is important to inform patients that LASIK only corrects the refractive aspect of myopia, not complications of the myopic eye
Blumenkranz, 2000133,155 eyesLASIK0.064% = N/ARD following LASIK will remain a relatively small problem in the United States
Ruiz-Moreno et al., 1999291,554 myopic eyes (−13.52 ± 3.38 D; −8.00 to −27.50 D)LASIK0.25% = 30.34 ± 10.27 monthsLASIK for correction of myopia is followed by a low visual acuity incidence of RD
Stulting et al., 1999521,062 myopic eyes (−7.57 D; −2.00 to −22.50 D)LASIK0.09% = 9.5 monthsRD was a cause of a two or more lines loss in CDVA in a patient with SER −22.50 D

Incidence of Retinal Detachment Following LASIK

StudyPopulationRisk in % (95% CI)
Arevalo et al., 20121422,7920.190 (0.137 to 0.254)
Qin et al., 20074818,3420.033 (0.012 to 0.071)
Faghihi et al., 20063459,5240.082 (0.061 to 0.109)
Lee et al., 2006337,0650.084 (0.031 to 0.185)
Feki et al., 20051614,0150.064 (0.029 to 0.122)
Arevalo et al., 20024938,8230.080 (0.054 to 0.113)
Arevalo et al., 20012131,7390.060 (0.036 to 0.093)
Aras et al., 2000504,4320.022 (0.001 to 0.126)
Arevalo et al., 20001229,9160.047 (0.026 to 0.079)
Blumenkranz, 2000133,1550.064 (0.008 to 0.229)
Ruiz-Moreno et al., 1999291,5540.250 (0.070 to 0.658)
Stulting et al., 1999521,0620.090 (0.002 to 0.524)
Overall232,4190.080 (0.069 to 0.092)

Annual Incidence of Retinal Detachmenta

ParameterIncidence
For different refractive errors
  Emmetropia and hyperopia0.003%
  Myopia up to −3.00 D0.015%
  Myopia ranging from −3.10 to −5.00 D0.015%
  Myopia greater than −5.00 D0.102%
For different age groups
  10–19 years0.0015%
  20–29 years0.0038%
  30–39 years0.0028%
  40–49 years0.0048%
  50–59 years0.0116%
  60–69 years0.0183%
  70–79 years0.0230%

Search Strategy

Literature searches of the PubMed and Web of Science databases were conducted in December 31, 2018; the search strategies are as follows. Specific limited update searches were conducted after December 31, 2018.

A.1. PubMed Search (Publication Date 1/1/1900–12/31/2018)

(((“retinal detachment”[Title]) OR (“retinal tear”[Title]) OR (“lattice degeneration”[Title]) OR (“posterior segment complications”[Title]) OR (“posterior vitreous detachment”[Title])) AND ((“corneal refractive surgery”[Title]) OR (“excimer laser”[Title]) OR (“femtosecond laser”[Title]) OR (“laser in situ keratomileusis”[Title]) OR (“LASIK”[Title]) OR (“laser epithelial keratomileusis”[Title]) OR (“LASEK”[Title]) OR (“photorefractive keratectomy”[Title]) OR (“PRK”[Title]) OR (“small incision lenticule extraction”[Title]) OR (“SMILE”[Title]))). 53 references.

A.2. Web of Science Search (Publication Date 1/1/1900–12/31/2018)

((TI=(retinal detachment) OR TI=(retinal tear) OR TI=(lattice degeneration) OR TI=(posterior segment complications) OR TI=(posterior vitreous detachment)) AND (TI=(corneal refractive surgery) OR TI=(excimer laser) OR TI=(femtosecond laser) OR TI=(laser in situ keratomileusis) OR TI=(LASIK) OR TI=(laser epithelial keratomileusis) OR TI=(LASEK) OR TI=(photorefractive keratectomy) OR TI=(PRK) OR TI=(small incision lenticule extraction) OR TI=(SMILE)) Indexes=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, BKCI-S, BKCI-SSH, ESCI, CCR-EXPANDED, IC Timespan=All years. 63 references.

Authors

From the Department of Ophthalmology, Hygeia Clinic, Gdansk, Poland (PK); the Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland (AG); and Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland (AG).

Dr. Kanclerz reports non-financial support from Visim and Optopol Technologies. Dr. Grzybowski reports non-financial support from Bayer, Novartis, and Alcon, personal fees and non-financial support from Valeant, grants from Zeiss, and personal fees and non-financial support from Santen.

AUTHOR CONTRIBUTIONS

Study concept and design (PK, AG); data collection (PK); analysis and interpretation of data (PK, AG); writing the manuscript (PK); critical revision of the manuscript (AG); statistical expertise (PK, AG); administrative, technical, or material support (AG); supervision (AG)

Correspondence: Andrzej Grzybowski, MD, PhD, MBA, Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 60-554 Gorczyczewskiego 2/3, Poznan, Poland. E-mail: ae.grzybowski@gmail.com

Received: April 19, 2019
Accepted: July 09, 2019

10.3928/1081597X-20190710-02

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