Chan Clara C, Rootman David S
Toronto Western Hospital, Department of Ophthalmogy, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Cornea. 2003 Oct;22(7):679-83. doi: 10.1097/00003226-200310000-00013.
To describe a case of localized midperipheral corneal steepening after laser in situ keratomileusis (LASIK) to correct hyperopia induced by radial keratotomy (RK) overcorrection.
A retrospective case observation of an unusual case.
Five years after bilateral RK (with eight incisions) performed out of the country, a 43-year-old woman underwent LASIK in her right eye. Preoperatively, manifest refraction was + 7.75 - 1.00 x 104. Four months after LASIK, the patient's UCVA was 20/70, manifest refraction was + 2.25 - 1.25 x 103, and LASIK enhancement with flap recutting was performed. One month later, the patient complained of a 1-day history of pain and photophobia. UCVA was 20/40, and a RK incision had opened. The eye was covered with a bandage contact lens (BCL) and TobraDex drops prescribed. The following day, the BCL was removed, and UCVA was 20/200. Four days later, the patient's UCVA was 20/25. Five and a half months after LASIK enhancement, the dehisced RK incision was closed, UCVA was 20/30, and manifest refraction was + 1.25 - 1.25 x 85. One year after enhancement, UCVA deteriorated to 20/70 with manifest refraction of - 1.00 - 1.25 x 40. Localized midperipheral corneal steepening on topography also seemed to be developing.
In LASIK surgery after RK, there is an inherent weakness of the cornea. Although visual acuity after RK-induced hyperopia may be improved by LASIK, the long-term refractive stability of the procedure is uncertain. Patients who undergo such a procedure should be monitored for developing localized midperipheral corneal steepening and be informed that such a complication can occur.
描述1例准分子原位角膜磨镶术（LASIK）矫正放射状角膜切开术（RK）过度矫正所致远视后出现局限性周边角膜陡峭的病例。
对1例特殊病例进行回顾性病例观察。
在国外行双侧RK（8条切口）5年后，一名43岁女性右眼接受了LASIK手术。术前，明显验光为+7.75 - 1.00×104。LASIK术后4个月，患者的最佳矫正视力（UCVA）为20/70，明显验光为+2.25 - 1.25×103，遂行带蒂瓣重新切割的LASIK增效手术。1个月后，患者主诉有1天的疼痛和畏光病史。UCVA为20/40，一条RK切口裂开。眼部覆盖绷带式隐形眼镜（BCL）并开具了托百士滴眼液。次日，移除BCL，UCVA为20/200。4天后，患者的UCVA为20/25。LASIK增效手术5个半月后，裂开的RK切口闭合，UCVA为20/30，明显验光为+1.25 - 1.25×85。增效手术后1年，UCVA恶化为20/70，明显验光为 - 1.00 - 1.25×40。地形图显示局限性周边角膜陡峭似乎也在发展。
RK术后行LASIK手术时，角膜存在内在薄弱点。尽管LASIK可能改善RK所致远视后的视力，但该手术的长期屈光稳定性尚不确定。接受此类手术的患者应监测是否出现局限性周边角膜陡峭，并被告知可能发生此类并发症。
