Kymionis George, Ide Takeshi, Yoo Sonia
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami University, Miami, FL 33136, USA.
Eur J Ophthalmol. 2009 Mar-Apr;19(2):301-3. doi: 10.1177/112067210901900223.
To report a patient with severe post-laser in situ keratomileusis (LASIK) epithelial ingrowth and keratolysis treated with flap amputation and phototherapeutic keratectomy (PTK) with adjuvant intraoperative mitomycin C (MMC).
Case report.
A 55-year-old woman was referred to our department due to severe post-LASIK epithelial ingrowth with corneal melting 2 years after primary LASIK. The patient had had two previous attempts for epithelial ingrowth treatment (flap lift and epithelial ingrowth manual removal) that were unsuccessful. Slit lamp biomicroscopy and anterior segment optical coherence tomography showed extensive epithelial ingrowth and keratolysis (thinning of the LASIK flap) while the patient had photophobia and could not tolerate contact lenses. Flap amputation with subsequent PTK (in order to smooth out the corneal irregularities caused by the keratolysis and/or variations in flap thickness) and adjuvant intraoperative MMC application for 2 minutes was performed. There were no intra- or postoperative adverse events seen during the follow-up period. Six months after the procedure, uncorrected visual acuity improved to 20/40 compared with 20/50 preoperatively, while best spectacle-corrected visual acuity improved from 20/40 to 20/32. The topographic astigmatism was decreased from 3.24 diopters (D) to 1.00 D.
Flap amputation with PTK and adjuvant intraoperative MMC is an option for the management of severe post-LASIK epithelial ingrowth with keratolysis.
报告一例接受瓣切除术联合光治疗性角膜切削术（PTK）及术中辅助使用丝裂霉素C（MMC）治疗的严重准分子原位角膜磨镶术（LASIK）后上皮内生和角膜溶解的患者。
病例报告。
一名55岁女性因初次LASIK术后2年出现严重的LASIK后上皮内生伴角膜溶解被转诊至我科。该患者此前曾两次尝试治疗上皮内生（掀起角膜瓣和手动清除上皮内生），均未成功。裂隙灯生物显微镜检查和眼前节光学相干断层扫描显示广泛的上皮内生和角膜溶解（LASIK瓣变薄），同时患者畏光且无法耐受隐形眼镜。进行了瓣切除术，随后进行PTK（以消除角膜溶解和/或瓣厚度变化引起的角膜不规则），并在术中辅助应用MMC 2分钟。随访期间未观察到术中或术后不良事件。术后6个月，裸眼视力从术前的20/50提高到20/40，最佳矫正视力从20/40提高到20/32。角膜地形图散光从3.24屈光度（D）降至1.00 D。
瓣切除术联合PTK及术中辅助MMC是治疗严重LASIK后上皮内生伴角膜溶解的一种选择。
