准分子激光角膜原位磨镶术联合角膜交联加固术后角膜形态参数异常评估的经验与教训

doi:10.6040/j.issn.1673-3770.0.2021.337

摘要/Abstract

摘要： 继发性角膜后扩张是一种角膜手术后出现的进行性角膜厚度变薄,角膜前表面曲率和后表面高度增加为特征的罕见疾病。通常见于激光角膜屈光手术后几月到几年间,患者术前往往有或无不典型的圆锥角膜早期表现。角膜交联手术通过增加角膜胶原纤维之间的连接来加固角膜。准分子激光角膜原位磨镶术LASIK联合角膜交联手术可以增加LASIK术后角膜的生物力学,防止术后屈光回退和继发性角膜后扩张。报告一例31岁女性患者在行LASIK联合角膜交联手术后出现罕见的角膜形态学参数改变。患者术后1个月复查时Pentacam检查表现出角膜厚度异常变薄,角膜后表面高度增高,容易被误诊为继发性角膜后扩张。通过眼前节光学相干断层成像的测量,发现角膜厚度存在较大差异,并且在长时间随访中,患者的Pentacam检查结果恢复正常。虽然Pentacam可以相对准确的测量角膜厚度、角膜曲率和前后表面的高度,但在LASIK联合角膜交联手术后出现可疑继发性角膜后扩张时,应同时进行其他设备的检查,避免出现假阳性的可能。

关键词: 准分子激光角膜原位磨镶术, 角膜交联, 角膜地形图, 角膜扩张, 厚度

Abstract: Secondary posterior corneal ectasia is a rare disease characterized by the progressive thinning of the corneal thickness and increased anterior surface curvature and posterior surface height following corneal surgery. It is usually observed in months to years following laser corneal refractive surgery. Patients often had or did not have atypical early manifestations of keratoconus before the operation. Corneal cross-linking surgery strengthens the cornea by increasing the connection between the corneal collagen fibers. Laser in situ keratomileusis combined with corneal cross-linking surgery can increase the biomechanics of the cornea after LASIK, and prevent postoperative refractive regression and secondary corneal ectasia. We report the case of a 31-year-old female with rare changes in the corneal morphological parameters following LASIK combined with corneal crosslinking surgery. One month after the operation, Pentacam revealed abnormal thinning of the corneal thickness and increased height of the posterior corneal surface, which was easily misdiagnosed as secondary corneal ectasia. Upon measurement by anterior segment optical coherence tomography, a significant difference in the corneal thickness was observed, and the results of the Pentacam returned to normal during long-term follow-up. Although Pentacam can relatively accurately measure the corneal thickness, corneal curvature, and height of the anterior and posterior surfaces, other equipment should be used simultaneously to examine suspected secondary corneal ectasia following LASIK combined with corneal cross-linking surgery in order to avoid the possibility of a false positive.

Key words: Laser in-situ keratom ileusis(LASIK), Corneal cross-linking, Corneal morphology, Corneal ectasia, Thickness

中图分类号:

R778.1

魏升升,李晶,刘建国,王利,杜婧,高金荣,李勇. 准分子激光角膜原位磨镶术联合角膜交联加固术后角膜形态参数异常评估的经验与教训[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 59-64.

WEI Shengsheng, LI Jing, LIU Jianguo, WANG Li, DU Jing, GAO Jinrong, LI Yong. Experience and lessons of evaluation of corneal morphologic parameters following laser in situ keratomileusis combined with corneal cross-linking surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 59-64.

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