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小切口透镜取出术后弥漫性层状角膜炎的非典型表现：无菌性多灶性炎症性角膜炎。

Atypical presentation of diffuse lamellar keratitis after small-incision lenticule extraction: Sterile multifocal inflammatory keratitis.

机构信息

From the London Vision Clinic (Reinstein, Stuart, Vida, Archer, Carp), London, United Kingdom; Department of Ophthalmology (Reinstein), Columbia University Medical Center, New York, New York, USA; Centre Hospitalier National d'Ophtalmologie (Reinstein), Paris, France; Biomedical Science Research Institute (Reinstein), University of Ulster, Coleraine, Northern Ireland.

出版信息

J Cataract Refract Surg. 2018 Jun;44(6):774-779. doi: 10.1016/j.jcrs.2018.03.020. Epub 2018 Jun 6.

DOI:10.1016/j.jcrs.2018.03.020

PMID:29885775

Abstract

We describe a case of atypical diffuse lamellar keratitis (DLK) following small-incision lenticule extraction (SMILE). The patient presented with multiple focal white infiltrates 1 day after routine small-incision lenticule extraction surgery. An interface washout was performed, and the patient was managed with intensive topical steroids. Potential infectious keratitis was also investigated (by culture and Gram stain) and treated aggressively with steroids and antibiotics. The cultures were all negative with no growth, and the focal infiltrates gradually resolved, with no relapses at the 15-month postoperative follow-up and a faint 0.7 mm superior scar in the right eye. This case highlights the importance of using intensive topical steroids as well as performing an interface washout in such cases because of the higher risk for corneal melting associated with focal infiltrates.

摘要

我们描述了一例在微创小切口角膜透镜取出术（SMILE）后出现的非典型弥漫性层状角膜炎（DLK）。患者在常规微创小切口角膜透镜取出手术后 1 天出现多处局灶性白色浸润。进行了界面冲洗，患者接受了强化局部皮质类固醇治疗。还对潜在的感染性角膜炎进行了检查（通过培养和革兰氏染色），并积极使用皮质类固醇和抗生素进行治疗。培养均无生长，局灶性浸润逐渐消退，术后 15 个月随访时无复发，右眼有 0.7mm 微弱的上方瘢痕。本例强调了在这种情况下使用强化局部皮质类固醇和进行界面冲洗的重要性，因为局灶性浸润与角膜融解的风险更高有关。