Labiris Georgios, Panagiotopoulou Eirini-Kanella, Ntonti Panagiota, Taliantzis Sergios
Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
J Med Case Rep. 2019 Sep 19;13(1):296. doi: 10.1186/s13256-019-2238-x.
According to experimental and clinical published studies, patients with keratoconus have a genetic predisposition to corneal ectasia; however, ectasia might not be activated or reactivated unless an additional stressful event triggers the disease. Triggering factors are sources of reactive oxidative stress; among them, mechanical trauma (vigorous eye rubbing, poorly fit contact lenses), exposure to ultraviolet light, and atopy/allergies. The aim of this case report is to present for the first time a case of rapidly progressive corneal ectasia in a patient with keratoconus following uncomplicated phacoemulsification surgery for cataract removal.
A 38-year-old Caucasian man was referred to our out-patient's service due to bilateral cataract. He also had bilateral keratoconus and had undergone corneal cross-linking in both his eyes 5 years prior to his referral. Ever since the corneal cross-linking, keratoconus had been stable. He underwent a full ophthalmological examination including slit-lamp biomicroscopy, optical biometry, Scheimpflug tomography, corneal biomechanical assessment, and fundus examination. He presented advanced centrally located cataract with count fingers for preoperative best-corrected visual acuity. An uncomplicated cataract extraction surgery was performed. Preoperative flat keratometry reading was 40.5 diopters, steep keratometry reading was 41.8 diopters, astigmatism was 1.3 diopters, corneal hysteresis was 8.2, corneal resistance factor was 7.5, and thinnest corneal thickness was 503 μm. Within 3 months, he demonstrated rapidly progressing corneal ectasia in his operated eye, while 6 months postoperatively, flat keratometry reading was 45.5 diopters, steep keratometry reading was 48.3 diopters, astigmatism was 2.8 diopters, corneal hysteresis = 6.8, corneal resistance factor = 7.5, and thinnest corneal thickness = 318 μm.
To the best of our knowledge, this is the first report to describe corneal ectasia in a patient with keratoconus following phacoemulsification surgery. Cataract surgeons should provide extra caution to patients with keratoconus and take into consideration this rare but potentially sight-threatening complication.
根据已发表的实验和临床研究，圆锥角膜患者具有角膜扩张的遗传易感性；然而，除非有额外的应激事件触发该疾病，否则扩张可能不会被激活或重新激活。触发因素是活性氧化应激的来源；其中包括机械创伤（用力揉眼、佩戴不合适的隐形眼镜）、紫外线照射以及特应性/过敏。本病例报告的目的是首次呈现一例在白内障摘除的单纯超声乳化手术后，圆锥角膜患者出现快速进展性角膜扩张的病例。
一名38岁的白人男性因双侧白内障被转诊至我们的门诊。他还患有双侧圆锥角膜，在转诊前5年双眼均接受过角膜交联术。自角膜交联术后，圆锥角膜病情一直稳定。他接受了全面的眼科检查，包括裂隙灯生物显微镜检查、光学生物测量、眼前节分析系统断层扫描、角膜生物力学评估和眼底检查。他术前最佳矫正视力为眼前指数，存在中央型晚期白内障。进行了一次无并发症的白内障摘除手术。术前平坦角膜曲率读数为40.5屈光度，陡峭角膜曲率读数为41.8屈光度，散光为1.3屈光度，角膜滞后为8.2，角膜阻力因子为7.5，最薄角膜厚度为503μm。在3个月内，他手术眼的角膜扩张迅速进展，而术后6个月时，平坦角膜曲率读数为45.5屈光度，陡峭角膜曲率读数为48.3屈光度，散光为2.8屈光度，角膜滞后 = 6.8，角膜阻力因子 = 7.5，最薄角膜厚度 = 318μm。
据我们所知，这是第一份描述超声乳化手术后圆锥角膜患者出现角膜扩张的报告。白内障手术医生应对圆锥角膜患者格外谨慎，并考虑到这种罕见但可能威胁视力的并发症。
