Sunderland Eye Infirmary (D.S.J.T., S.G.), Queen Alexandra Road, Sunderland, United Kingdom; and Academic Ophthalmology (D.S.J.T.), Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
Eye Contact Lens. 2019 Jul;45(4):e15-e23. doi: 10.1097/ICL.0000000000000575.
To highlight the clinical characteristics, and visual and corneal tomographic outcomes of central toxic keratopathy (CTK) after contact lens (CL) wear and mechanical debridement.
A retrospective observational case series with literature review.
Four patients (4 eyes) were included in this study; 3 (75%) females, mean age 29.3±8.1 years. The mean follow-up was 13.5±7.5 months. Early central or paracentral stromal opacification, assuming an inverse dome-shaped pattern observed under anterior-segment optical coherence tomography, with corneal flattening (Kmean 40.4±1.3 D) and thinning (mean thinnest pachymetry=404.8±29.4 microns) were observed in all cases. All patients had a recent use of CL wear, with three after mechanical debridement for recurrent corneal erosion syndrome. None of them had any previous laser refractive surgery (LRS). The mean corrected distance visual acuity improved from 20/40 (ranged 20/25-20/50) initially to 20/30 (ranged 20/20-20/40) at final follow-up, and the outcome was not influenced by the use of topical steroids. A mean improvement of corneal flattening (+Kmean 1.2±1.2 D), thinning (+123.5±23.8 microns), and astigmatism (-3.0±2.7 D), via epithelial and stromal remodeling, was observed up to 15 months after CTK. Persisting reduced corneal sensation was noted in all patients at the final follow-up.
Central toxic keratopathy is not an exclusive complication of LRS, and it may occur after CL wear and mechanical debridement. Our findings are similar to those of LRS-related CTK and toxic peripheral keratopathy. Awareness of the clinical associations and understanding of the clinical course and tomographic characteristics of CTK helps obviate unnecessary investigation and overtreatment. Further studies are required to elucidate the underlying pathogenesis of this rare clinical entity.
强调接触镜（CL）佩戴和机械清创后中央毒性角膜病（CTK）的临床特征、视力和角膜断层成像结果。
一项回顾性观察性病例系列研究，结合文献复习。
本研究纳入了 4 名患者（4 只眼）；3 名女性（75%），平均年龄 29.3±8.1 岁。平均随访时间为 13.5±7.5 个月。所有患者均观察到早期中央或旁中央基质混浊，前节光学相干断层扫描下呈倒穹顶样模式，角膜变平（Kmean 40.4±1.3 D）和变薄（最薄点厚度平均值=404.8±29.4 微米）。所有患者均有近期佩戴 CL 的病史，其中 3 例因复发性角膜上皮糜烂综合征而进行机械清创。他们均无任何既往激光屈光手术（LRS）。平均矫正视力从初始的 20/40（范围 20/25-20/50）改善至最终随访时的 20/30（范围 20/20-20/40），且结局不受局部类固醇的影响。通过上皮和基质重塑，观察到角膜变平（+Kmean 1.2±1.2 D）、变薄（+123.5±23.8 微米）和散光（-3.0±2.7 D）的平均改善，直至 CTK 后 15 个月。所有患者在最终随访时均存在持续性的角膜知觉减退。
中央毒性角膜病并非 LRS 的特有并发症，也可能发生在 CL 佩戴和机械清创后。我们的发现与 LRS 相关的 CTK 和毒性周边性角膜病相似。认识到临床相关性，并了解 CTK 的临床病程和断层成像特征，有助于避免不必要的检查和过度治疗。需要进一步研究阐明这一罕见临床实体的潜在发病机制。
