Roncone David P
Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA.
Optometry. 2011 Dec;82(12):751-6. doi: 10.1016/j.optm.2011.06.011. Epub 2011 Oct 22.
Keratoectasia is a rare but well-known complication after laser-assisted in situ keratomileusis (LASIK). Patients with this condition can have high and irregular astigmatism. When the treatment of the high astigmatic correction cannot be accomplished surgically or when the keratoectasia patient rejects surgical enhancement, optical correction with devices such as soft or rigid gas-permeable contact lenses may be pursued. In fact, toric soft contact lenses are a good first option for fitting postoperative keratoectasia patients.
A 58-year-old white male presented for an examination with a complaint of decreased distance vision in the right eye (OD) after having traditional LASIK for myopia with astigmatism in both eyes (OU) in 1999 and limbal relaxing incision enhancement OD in 2003. Refraction showed high mixed astigmatism OD (+1.75 -5.75×075). Slit lamp examination found irregularity of the cornea, evidenced by an inferior cone with pigmented Fleischer ring OD. Video keratometry had keratometry readings of 43.50 at 160, 39.87 at 070, elevated shape measure (0.40), elevated corneal irregularity measure (3.96), an inferior cone on the elevation map, and asymmetric bowtie with elongation inferonasally on the axial map, which confirmed the diagnosis of postoperative keratoectasia. Because new surgical treatments at that time for corneal ectasia were in their infancy and not approved by the U.S. Food and Drug Administration, the patient opted for a trial toric soft contact lens fitting, which improved his corrected distance visual acuity to 20/25.
This case report confirms that toric soft contact lenses are a good first choice in fitting patients with high and irregular astigmatism from postoperative LASIK corneal ectasia. It also confirms that excellent vision and comfort with toric soft contact lenses is possible in these patients.
角膜扩张是准分子激光原位角膜磨镶术（LASIK）后一种罕见但广为人知的并发症。患有这种疾病的患者可能有高度和不规则散光。当手术无法完成对高度散光的矫正，或者角膜扩张患者拒绝手术增强时，可以采用软性或硬性透气接触镜等器械进行光学矫正。事实上，散光软性接触镜是术后角膜扩张患者配镜的一个很好的首选。
一名58岁白人男性前来就诊，主诉右眼（OD）远视力下降。该患者于1999年双眼（OU）行传统LASIK治疗近视合并散光，2003年右眼行角膜缘松解切口增强术。验光显示右眼有高度混合散光（+1.75 -5.75×075）。裂隙灯检查发现角膜不规则，右眼下方有圆锥角膜伴色素沉着的费氏环。角膜地形图检查显示在160°处角膜曲率读数为43.50，在070°处为39.87，形状测量值升高（0.40），角膜不规则测量值升高（3.96），高度图上有下方圆锥角膜，轴向图上有鼻下延长的不对称领结样改变，这些均证实了术后角膜扩张的诊断。由于当时针对角膜扩张的新手术治疗尚处于起步阶段且未获美国食品药品监督管理局批准，患者选择试用散光软性接触镜配镜，其矫正远视力提高到了20/25。
本病例报告证实，散光软性接触镜是术后LASIK角膜扩张所致高度和不规则散光患者配镜的良好首选。这也证实了这些患者使用散光软性接触镜可获得良好视力和舒适度。
