无明显术前危险因素的患者在准分子原位角膜磨镶术后发生角膜扩张。
Corneal ectasia after laser in situ keratomileusis in patients without apparent preoperative risk factors.
作者信息
Klein Shawn R, Epstein Randy J, Randleman J Bradley, Stulting R Doyle
机构信息
Cornea Service, Department of Ophthalmology, Rush University Medical Center, Chicago, IL 60612, USA.
出版信息
Cornea. 2006 May;25(4):388-403. doi: 10.1097/01.ico.0000222479.68242.77.
PURPOSE
To evaluate patients who developed ectasia with no apparent preoperative risk factors.
METHODS
Potential cases of patients who developed ectasia without apparent risk factors were identified by contacting participants in the Kera-Net (n = 580), ASCRS-Net (n = 450), and ISRS/AAO ISRS-Net (n = 525) internet bulletin boards from April to October 2003. Cases were included if ectasia developed after laser in situ keratomileusis in the absence of apparent preoperative risk factors. Reported cases were excluded for the following reasons: (1) calculated residual stromal bed less than 250 microm, (2) preoperative central pachymetry less than 500 microm, (3) any keratometry reading greater than 47.2 diopters (D), (4) a calculated inferior-superior value greater than 1.4, (5) more than 2 retreatments, (6) attempted initial correction greater than -12.00 D, (7) an Orbscan II "posterior float" (if obtained) greater than 50 microm, and (8) surgical/flap complications.
RESULTS
A total of 27 eyes of 25 patients were submitted for consideration. Eight eyes (8 patients) met our inclusion criteria. Mean age was 27.7 years (range, 18-41 years). Preoperative manifest refraction spherical equivalent was -4.61 D (range, -2.00 to -8.00 D); steepest keratometric reading was 43.86 D (range, 42.50-46.40 D); keratometric astigmatism was 0.93 D (range, 0.25-1.90 D); and preoperative central pachymetry was 537 microm (range, 505-560 microm). The mean calculated ablation depth was 82.8 microm (range, 21-125.4 microm), and mean calculated residual stromal bed was 299.5 microm (range, 254-373 microm). Mean time to recognition of ectasia onset was 14.2 months (range, 3-27 months) postoperatively. At the time of ectasia diagnosis, the mean manifest refraction spherical equivalent was -1.23 D (range, +0.125 to -3.00) with a mean of 2.72 D (range, 0.75-4.00 D) of astigmatism.
CONCLUSIONS
Ectasia can occur after an otherwise uncomplicated laser in situ keratomileusis procedure, even in the absence of apparent preoperative risk factors.
目的
评估那些出现扩张但术前无明显危险因素的患者。
方法
通过联系2003年4月至10月参与Kera-Net（n = 580）、ASCRS-Net（n = 450）和ISRS/AAO ISRS-Net（n = 525）互联网公告栏的参与者，确定那些出现扩张且无明显危险因素的潜在患者病例。如果在无明显术前危险因素的情况下，准分子原位角膜磨镶术后出现扩张，则纳入病例。以下原因的报告病例被排除：（1）计算得出的残余基质床小于250微米，（2）术前中央角膜厚度小于500微米，（3）任何角膜曲率读数大于47.2屈光度（D），（4）计算得出的上下差值大于1.4，（5）超过2次再次治疗，（6）首次尝试矫正度数大于 -12.00 D，（7）Orbscan II“后表面浮动”（如果有）大于50微米，以及（8）手术/瓣相关并发症。
结果
共有25例患者的27只眼被提交审议。8只眼（8例患者）符合我们的纳入标准。平均年龄为27.7岁（范围18 - 41岁）。术前明显验光球镜等效值为 -4.61 D（范围 -2.00至 -8.00 D）；最陡角膜曲率读数为43.86 D（范围42.50 - 46.40 D）；角膜散光为0.93 D（范围0.25 - 1.90 D）；术前中央角膜厚度为537微米（范围505 - 560微米）。平均计算消融深度为82.8微米（范围21 - 125.4微米），平均计算残余基质床为299.5微米（范围254 - 373微米）。扩张开始被识别的平均时间为术后14.2个月（范围3 - 27个月）。在扩张诊断时，平均明显验光球镜等效值为 -1.23 D（范围 +0.125至 -3.00），散光平均为2.72 D（范围0.75 - 4.00 D）。
结论
即使在无明显术前危险因素的情况下，在其他方面无并发症的准分子原位角膜磨镶术之后也可能发生扩张。
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