Xie Wenjia, Xu Yesheng, Yao Yu-Feng
Department of Ophthalmology Sir Run Run Shaw Hospital Zhejiang University School of Medicine Hangzhou, China (all authors) *
Optom Vis Sci. 2018 Jan;95(1):76-81. doi: 10.1097/OPX.0000000000001163.
As patients with previous radial keratotomy (RK) are still occasionally encountered, recognition of the anatomy of post-RK corneas and management of their complications remain relevant. High-definition anterior segment optical coherence tomography (AS-OCT) is a very useful tool to assess these postsurgical corneas.
To describe a case of acute corneal hydrops with Descemet membrane schisis after RK with observation by AS-OCT.
A 43-year-old woman presented with a 9-day history of sudden vision loss, foreign body sensation, and photophobia in her left eye. She had undergone bilateral RK 25 years ago at her local hospital. Slit-lamp examination revealed marked corneal edema and stromal clefts in the central cornea along with radial surgical scars in her left eye. Pentacam imaging showed the typical pattern of a post-RK cornea with ectasia in her right eye. Multiple dilacerations of collagen lamellae and fluid-filled intrastromal cysts together with epithelial edema were observed in her left eye using AS-OCT. A Descemet membrane detachment with schisis was also shown by AS-OCT. After 5 months of medication with topical 0.1% fluorometholone eye drops four times daily together with 3% ofloxacin eye ointment once daily, the corneal edema, Descemet membrane detachment, and Descemet membrane schisis had completely resolved resulting in pan-stromal scarring.
This report describes acute corneal hydrops with Descemet membrane schisis after RK imaged using high-definition AS-OCT. The acute hydrops was possibly caused by corneal ectasia or underlying keratoconus, which was aggravated by RK. High-definition AS-OCT is a useful tool to demonstrate the details of different corneal layers and to observe the resolving process of acute hydrops. Topical medications consisting of antibiotic, lubrication, and corticosteroid can be used to treat the acute event effectively.
由于既往接受过放射状角膜切开术（RK）的患者仍偶尔会遇到，因此认识RK术后角膜的解剖结构并处理其并发症仍然具有重要意义。高清眼前节光学相干断层扫描（AS-OCT）是评估这些术后角膜的非常有用的工具。
描述1例RK术后发生急性角膜水肿合并后弹力层分离的病例，并通过AS-OCT进行观察。
一名43岁女性，左眼突发视力下降、异物感和畏光9天。25年前她在当地医院接受了双侧RK手术。裂隙灯检查显示左眼中央角膜有明显的角膜水肿和基质裂，以及放射状手术瘢痕。Pentacam成像显示右眼为典型的RK术后角膜扩张模式。使用AS-OCT观察到左眼胶原板层多处撕裂、基质内充满液体的囊肿以及上皮水肿。AS-OCT还显示了后弹力层分离伴劈裂。每天4次局部使用0.1%氟米龙滴眼液并联合每天1次3%氧氟沙星眼膏治疗5个月后，角膜水肿、后弹力层脱离和后弹力层劈裂完全消退，导致全基质瘢痕形成。
本报告描述了RK术后急性角膜水肿合并后弹力层分离，并使用高清AS-OCT进行成像。急性水肿可能是由角膜扩张或潜在的圆锥角膜引起的，RK手术使其加重。高清AS-OCT是展示不同角膜层细节以及观察急性水肿消退过程的有用工具。由抗生素、润滑剂和皮质类固醇组成的局部药物可有效治疗急性病变。
