Hsu Joseph K W, Johnston W Todd, Read Russell W, McDonnell Peter J, Pangalinan Rey, Rao Narsing, Smith Ronald E
Doheny Eye Institute, Los Angeles, California, USA.
J Cataract Refract Surg. 2003 Feb;29(2):250-6. doi: 10.1016/s0886-3350(02)01702-9.
To describe the histopathology of the cornea in 3 cases of corneal melting associated with diclofenac therapy after refractive surgery procedures.
Clinic and pathology laboratory.
Three cases of corneal melting associated with diclofenac therapy (2 after laser in situ keratomileusis [LASIK] and 1 after mini-radial keratectomy enhancement of a LASIK undercorrection) were studied using patient and referring physician interviews, chart reviews, and histopathologic examination of the corneal tissue.
In all 3 cases, the flaps were dislocated and the stromal corneal bed was exposed. Diclofenac, generic or brand name, was used in all cases; in 1 case, both generic and brand name were used. Dosing and duration varied, but in all 3 cases diclofenac was used at least 4 times a day for at least 3 days after LASIK. Topical steroids were also prescribed, but 1 patient did not use them. Preoperative medical conditions were present in 2 cases. Histologic analysis showed evidence of an inflammatory response in advanced cases and keratolysis and lack of inflammatory cells in the flaps that were amputated early.
The use of generic or brand-name diclofenac with or without adjunctive topical steroids after LASIK can be associated with corneal melting when the LASIK flap is dislodged and the corneal stromal bed exposed. Caution is recommended with diclofenac use after LASIK in such cases.
描述3例屈光手术后与双氯芬酸治疗相关的角膜溶解的组织病理学特征。
诊所及病理实验室。
通过对患者及转诊医生进行访谈、查阅病历以及对角膜组织进行组织病理学检查，研究了3例与双氯芬酸治疗相关的角膜溶解病例（2例发生于准分子原位角膜磨镶术[LASIK]后，1例发生于对LASIK欠矫进行的微小放射状角膜切开术增强术后）。
在所有3例病例中，角膜瓣均发生移位，角膜基质床暴露。所有病例均使用了双氯芬酸，无论是通用名还是商品名；1例同时使用了通用名和商品名。用药剂量和持续时间各不相同，但在所有3例病例中，LASIK术后双氯芬酸均每天至少使用4次，至少持续3天。也开具了局部用类固醇药物，但有1例患者未使用。2例患者存在术前疾病。组织学分析显示，晚期病例有炎症反应的证据，而早期切除的角膜瓣有角膜溶解且无炎症细胞。
LASIK术后使用通用名或商品名双氯芬酸，无论是否联合局部用类固醇药物，当LASIK角膜瓣移位且角膜基质床暴露时，可能会导致角膜溶解。在此类情况下，LASIK术后使用双氯芬酸时建议谨慎。
