激光角膜屈光术后继发圆锥角膜的临床特征及治疗预后分析  

Clinical features and treatment prognosis of secondary keratoconus after laser corneal refractive surgery

作　　者：吴跃兰 张晓玉 孙禹 孙亚如 张阳阳 亓晓琳 高华 Wu Yuelan;Zhang Xiaoyu;Sun Yu;Sun Yaru;Zhang Yangyang;Qi Xiaolin;Gao Hua(College of Medicine of Qingdao University,Qingdao 266071,China;Eye Hospital of Shandong First Medical University,Jinan 250021,China;Qingdao Eye Hospital of Shandong First Medical University,Qingdao 266071,China)

机构地区：[1]青岛大学医学部,青岛266071 [2]山东第一医科大学附属眼科医院(山东省眼科医院)山东第一医科大学(山东省医学科学院)山东省眼科研究所山东省眼科学重点实验室-省部共建国家重点实验室培育基地,济南250021 [3]山东第一医科大学附属青岛眼科医院山东第一医科大学附属眼科医院,青岛266071

出　　处：《临床眼科杂志》2023年第4期289-293,共5页Journal of Clinical Ophthalmology

基　　金：国家自然科学基金项目(81870639、82070923);泰山学者计划(201812150);山东第一医科大学学术提升计划(2019RC009)。

摘　　要：目的分析激光角膜屈光术后继发圆锥角膜的发病特征和临床表现,并评估其治疗预后。方法回顾性病例研究。收集2013年1月至2021年12月于山东第一医科大学附属眼科医院(山东省眼科医院)就诊的激光角膜屈光术后继发圆锥角膜的患者27例(54只眼),其中男性患者22例,女性患者5例,4例单眼发病,23例双眼发病,患者年龄为19~48岁,平均(28.6±5.9)岁。分析其发病特征、临床分期、角膜地形图的参数资料、治疗方法和疗效。结果27例继发圆锥角膜患者术前的屈光手术方式为:准分子激光原位角膜磨镶术(LASIK)24例,准分子激光角膜上皮瓣下磨镶术(LASEK)1例,经上皮准分子激光屈光性角膜切削术(Trans PRK)1例,飞秒激光基质透镜切除术(FLEx)1例。患者接受角膜屈光手术的年龄为15~34岁,平均(19.4±3.6)岁。27例(54只眼)患者中,潜伏期4只眼,初发期16只眼,完成期34只眼。完成期患者均表现出角膜前突变薄,8只眼(24%)可见Fleischer环、7只眼(21%)可见Vogt线。角膜地形图中角膜后表面形态表现为:初发期患者以桥型递增型(38%)和桥型递减型(25%)为主,完成期患者则以岛型(64%)和不完全岛型(18%)为主。初发期患者主要采用框架眼镜(50.0%)和透气性角膜接触镜(RGP)(31.3%)治疗,而完成期患者多数需行角膜交联术(CXL)(29.5%)或板层角膜移植术(LKP)(50.0%)手术治疗,17例接受LKP术的患者均为LASIK术后继发圆锥角膜患者。结论激光角膜屈光术后继发圆锥角膜以LASIK术后多见,初发期患者的角膜地形图后表面形态较少进展为岛型,完成期患者多数需行角膜交联术或角膜移植术手术治疗。Objective To analyze the characteristics,clinical manifestations and prognosis of secondary keratoconus after laser corneal refractive surgery.Methods In this retrospective case series study,a total of 27 patients(54 eyes)who were diagnosed with secondary keratoconus after laser corneal refractive surgery from January 2013 to December 2021 were recruited.There were 22 males and 5 females,4 cases of monocular disease and 23 cases of binocular disease.The age of these patients ranged from 19 to 48 years(28.6±5.9).The characteristics,clinical stages,corneal topography parameters,treatment and curative effect of the disease were analyzed.Results The preoperative refractive procedures of 27 patients with secondary keratoconus were as follows:laser in situ keratomileusis(LASIK)(24 cases),laser assisted subepithelial keratomileusis(LASEK)(1 case),trans epithelial photorefractive keratectomy(Trans PRK)(1 case),and femtosecond lenticule extraction(FLEx)(1 case).The average age of patients who underwent corneal refractive surgery was(19.4±3.6)years old.Among the 27 patients(54 eyes),there were 4 eyes in the incubation period,16 eyes in the subclinical stage and 34 eyes in the clinical stage.In clinical stage,all patients showed corneal central anterior bulging.The Fleischer ring was seen in 8 eyes(24%)and Vogt line was seen in 7 eyes(21%).The types of topography of the posterior surface in subclinical keratoconus eyes were mainly an increasing bridge(38%)and decreasing bridge(25%),and the clinical keratoconus eyes were mainly an incomplete island(64%)and island(18%).The patients in subclinical stage were mainly treated with spectacles(50.0%)and rigid gas permeable contact lens(RGP)(31.3%),while the patients in clinical stage were mostly treated with corneal crosslinking(CXL)(29.5%)or lamellar keratoplasty(LKP)(50.0%).The 17 patients who received LKP were all secondary keratoconus after LASIK.Conclusions The secondary keratoconus after laser corneal refractive surgery is more common after LASIK.The corneal topography of t

关 键 词：继发圆锥角膜 激光角膜屈光术后 临床特征 治疗 

分 类 号：R779.6[医药卫生—眼科]