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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。
OBJECTIVE: To report the follow-up results of 3-year follow-up of corneal keratoconus after one case of laser in situ keratomileusis (LASIK) treated with contact lens, and briefly review the relevant literature. METHODS: A 27-year-old female patient underwent routine LASIK for moderate myopia. Mydriatic optometry before the results of the right eye -5.50 / -0.50 × 50 ° and left eye -4.50 / -1.00 × 15 °. The central corneal thickness was 526 μm for the right eye and 541 μm for the left eye, respectively. Preoperative corneal topography was normal, did not show any keratoconus or subclinical keratoconus changes. The 160-μm corneal flap was laser-cut after surgery. The depth of cut was 102 μm for the right eye and 86 μm for the left eye, respectively. The remaining corneal thickness was estimated to be 264 μm and 295 μm. Results: At 29 months after surgery, the visual acuity of both eyes decreased, the cornea bulging in the lower part and the curvature of the central cornea becoming larger. Optometry results were right -12.50 / -4.00 × 160 ° and left-eye -6.00 / -4.25 × 125 °, respectively. Central corneal thickness thinning. Diagnosis of secondary keratoconus cornea, given rigid contact lens wear. 3a follow-up (during which the lens was changed twice) showed that the patient’s condition was basically stable, satisfactory vision correction, contact lens wear well all day, fewer complications. CONCLUSIONS: Although a rigorous preoperative screening, secondary to keratoconus may still occur after mild to moderate myopia LASIK. Hard contact lenses are a safe and reversible method of improving visual acuity in such patients and may also delay or prevent patients from implanting corneal stroma rings and penetrating keratoplasty.