角膜接触镜治疗LASIK术后继发性圆锥角膜——附1例报告(英文)  

Contact lens management of late onset bilateral keratectasia after laser in situ keratomileusis for myopia:a case report with review of literature

作　　者：杜红俊[1] 徐渊[1] 胡丹[1] 董责红[1] 王海燕[1] 王雨生[1] 

机构地区：[1]第四军医大学西京医院眼科全军眼科研究所,中国陕西省西安市710032

出　　处：《国际眼科杂志》2008年第11期2167-2172,共6页International Eye Science

基　　金：National Science and Technology Projects Foundation of China(No.2004BA720A16)~~

摘　　要：目的:报道1例角膜接触镜治疗准分子激光原位角膜磨镶术(laser in situ keratomi leusis,LASIK)术后双眼圆锥角膜3a随访结果,并对相关文献进行简要回顾。方法:一位27岁的女性患者行常规LASIK治疗中度近视。术前散瞳验光的结果为右眼-5.50 /-0.50×50°和左眼-4.50/-1.00×15°。中央角膜厚度分别为右眼526μm和左眼541μm。术前角膜地形图正常,没有显示任何圆锥角膜或者亚临床期圆锥角膜的改变。手术中制作160μm角膜瓣后进行激光切削,切削深度分别是右眼102μm和左眼86μm,预计剩余角膜厚度为264μm和295μm。结果:术后29mo,患者双眼出现明显视力下降,下方角膜膨出,中央角膜曲率变大。验光结果分别为右眼-12.50/-4.00×160°和左眼-6.00/-4.25×125°。中央角膜厚度变薄。诊断双眼继发性圆锥角膜,给予硬性角膜接触镜配戴。3a的随访(期间曾两次更换镜片)显示患者病情基本稳定,视力矫正满意,接触镜全天佩戴耐受性良好,并发症较少。结论:虽然经过严格的术前筛查,轻度到中度的近视LASIK治疗术后仍可能出现继发性圆锥角膜。硬性角膜接触镜是改善此类患者视力安全和可逆的方法,也可以延迟或避免患者进行角膜内基质环的植入和穿透性角膜移植。AIM. To present a case of late onset bilateral keratectasis after laser in situ keratomileusis （LASIK） for myopia with rigid gas-permeable contact lenses with a brief review of literature on this subject. METHODS： A 27-year-old woman underwent bilateral uneventful LASlK for moderate myopia. Preoperative cycloplegic refractions were -5.50/-0.50×50° right eye （OD） and -4.50/-1.00×15° left eye （OS）. Corneal pachymetry was 526μm OD and 541μm OS. Preoperative corneal topography was normal and did not reveal any keratoconus or forme fruste keratoconus, Following the creation of flaps with 160μm plates, ablations of 102μm OD and 86μm OS were performed, estimated to leave residual stromal beds of 264μ m OD and 295μm OS. RESULTS. Twenty-nine months postoperatively, the patient developed bilateral inferior keratectasia of-12.50/- 4.00×160° OD and -6.00/- 4.25 ×125° OS. Visual acuity was reduced in both eyes; the central cornea had steepened; and pachymetry showed central corneal thinning. Keratectasia was diagnosed, and rigid contact lenses were fitted. Three years later, the patient achieved satisfactory visual acuity and all-day lens wear with minimal complications. CONCLUSION. Late keratectasia may follow LASIK for low to moderate myopia despite a thorough preoperative work-up. Rigid contact lenses can offer a safe, reversible option for improving visual acuity in such patients by delaying or avoiding the need for intracorneal ring segments implanting or penetrating keratoplasty.

关 键 词：圆锥角膜 近视 准分子激光原位角膜磨镶术 角膜接触镜 

分 类 号：R779.63[医药卫生—眼科]