Progressive post-LASIK myopic retinoschisis: a rare complication and its management

To report a case of rapid progression of myopic macular retinoschisis (MRS) following femtosecond laser-assisted in situ keratomileusis (LASIK) and its anatomical outcome after pars plana vitrectomy (PPV). A 36-year-old woman with high myopia (right eye: 6/15, -14.75D; left eye: 6/12, -13.5D spherical equivalent) underwent a routine refractive surgery evaluation. Fundus examination revealed pathological myopia with posterior staphyloma and peripapillary atrophy in both eyes, while optical coherence tomography (OCT) demonstrated inner and outer MRS with focal vitreomacular traction in the right eye. Following an uneventful bilateral femtosecond LASIK procedure, the patient presented with visual blurring in the right eye at the two-month follow-up. OCT imaging showed significant progression of MRS with increased vitreomacular traction and central retinal thickness, leading to a decline in visual acuity to 6/24. Given the progressive nature of the pathology, PPV was performed. At 6-week and 4-month follow-ups, OCT demonstrated resolution of MRS with restoration of a normal foveal contour and thickness, and final visual acuity improved to 6/12. Femtosecond LASIK in highly myopic eyes with pre-existing tractional macular abnormalities may exacerbate MRS progression. Alternative refractive procedures should be considered in such cases. Early vitrectomy intervention may be beneficial for progressive MRS to achieve anatomical and functional improvement.