Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
Surv Ophthalmol. 2015 Mar-Apr;60(2):115-22. doi: 10.1016/j.survophthal.2014.08.003. Epub 2014 Aug 23.
Corneal dystrophies are a rare group of hereditary disorders, that are bilateral, non-inflammatory, and progressive. Clinically, they can be classified based on the anatomic layer of the cornea affected. Refractive surgery and phototherapeutic keratectomy (PTK) can be performed with caution in patients with certain corneal dystrophies, but should be avoided in others. For epithelial basement membrane dystrophy, photorefractive keratectomy (PRK) is the procedure of choice for treatment of refractive error, and PTK may be performed for the treatment of recurrent erosions or irregular astigmatism. PRK and laser-assisted in situ keratomileusis (LASIK) have been associated with exacerbation of combined granular-lattice corneal dystrophy. LASIK and PRK appear to be safe in mild forms of posterior polymorphous corneal dystrophy, whereas LASIK should be avoided in Fuchs dystrophy. The safety of refractive surgery and PTK in the remainder of epithelial, Bowman layer, and stromal dystrophies has yet to be established.
角膜营养不良是一组罕见的遗传性疾病，具有双侧性、非炎症性和进行性特征。临床上，可以根据受影响的角膜解剖层进行分类。对于某些角膜营养不良患者，可以谨慎进行屈光手术和光动力角膜切削术（PTK），但对于其他患者则应避免。对于上皮基底膜营养不良，光折射性角膜切削术（PRK）是治疗屈光不正的首选方法，PTK 可用于治疗复发性糜烂或不规则散光。PRK 和激光辅助原位角膜磨镶术（LASIK）与颗粒状-格子状角膜营养不良的恶化有关。LASIK 和 PRK 在轻度后多形性角膜营养不良中似乎是安全的，而 Fuchs 营养不良则应避免 LASIK。屈光手术和 PTK 在其余的上皮、Bowman 层和基质营养不良中的安全性尚未确定。
