准分子激光原位角膜磨镶术后角膜真菌病穿孔病例系列
Case Series of Perforated Keratomycosis after Laser-Assisted In Situ Keratomileusis.
作者信息
Eleiwa Taher, Ozcan Eyup, Abdelrahman Samar, Solyman Omar, Elhusseiny Abdelrahman M, Youssef Gehad, Bayoumy Ahmed
机构信息
Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
Department of Ophthalmology, Faculty of Medicine, Benha University, Egypt.
出版信息
Case Rep Ophthalmol Med. 2020 Sep 15;2020:7237903. doi: 10.1155/2020/7237903. eCollection 2020.
BACKGROUND
Fungal keratitis is an extremely rare complication of laser vision correction resulting in poor visual outcomes. Amniotic membrane transplantation should be kept in mind in eyes with corneal perforation prior to penetrating keratoplasty.
AIM
To assess the outcomes of multilayered fresh amniotic membrane transplantation (MLF-AMT) in patients with severe keratomycosis after laser-assisted in situ keratomileusis (LASIK). . Hospital-based prospective interventional case series.
METHODS
Five eyes of 5 patients were included in the study. All cases underwent microbiological scrapings from residual bed and intrastromal injections of amphotericin (50 mcg/mL), with flap amputation if needed, followed by topical 5% natamycin and 0.15% amphotericin. MLF-AMT was performed after corneal perforation. Later, penetrating keratoplasty (PK) was performed when corneal opacity compromised visual acuity. The outcome measures were complete resolution of infection, corneal graft survival, and best-corrected visual acuity (BCVA).
RESULTS
The mean age of patients was 22 ± 1.2 years with 4/5 (80%) were females. The mean interval between LASIK and symptom onset was 8.8 ± 1 day, and the mean interval between symptom onset and referral was 14 ± 1.4 days. Potassium hydroxide (KOH) smears showed filamentous fungi, and Sabouraud's medium grew Aspergillus in all cases. Melted flaps were amputated in 4 (80%) cases. MLF-AMT was performed in all cases due to corneal perforation after a mean time of 12.4 ± 1.2 days of antifungals. In all cases, complete resolution of infection was seen 26 ± 1.8 days after MLF-AMT, and optical PK was done at a mean of 2.4 months later. No postoperative complications after MLF-AMT or PK were observed, with a 0% incidence of corneal graft rejection, and a final BCVA ranged from 20/20 to 20/80 after a mean follow-up of 14 ± 1.1 months.
CONCLUSION
MLF-AMT is a safe and valid option to manage corneal perforation during keratmycosis treatment to avoid emergency therapeutic keratoplasty.
背景
真菌性角膜炎是激光视力矫正极为罕见的并发症，会导致视力预后不佳。在穿透性角膜移植术前，对于角膜穿孔的眼睛应考虑羊膜移植。
目的
评估多层新鲜羊膜移植术（MLF - AMT）治疗准分子原位角膜磨镶术（LASIK）后严重角膜真菌病患者的疗效。基于医院的前瞻性干预病例系列研究。
方法
本研究纳入5例患者的5只眼睛。所有病例均从残留床进行微生物刮片，并进行两性霉素基质内注射（50μg/mL），必要时切除角膜瓣，随后局部应用5%那他霉素和0.15%两性霉素。角膜穿孔后行MLF - AMT。之后，当角膜混浊影响视力时行穿透性角膜移植术（PK）。观察指标包括感染完全消退、角膜移植存活情况以及最佳矫正视力（BCVA）。
结果
患者平均年龄为22±1.2岁，5例中有4例（80%）为女性。LASIK与症状出现的平均间隔时间为8.8±1天，症状出现与转诊的平均间隔时间为14±1.4天。氢氧化钾（KOH）涂片显示丝状真菌，所有病例在沙氏培养基上均培养出曲霉菌。4例（80%）患者的角膜瓣被切除。由于抗真菌治疗平均12.4±1.2天后出现角膜穿孔，所有病例均行MLF - AMT。所有病例在MLF - AMT后26±1.8天感染完全消退，平均2.4个月后行光学性PK。MLF - AMT或PK术后未观察到并发症，角膜移植排斥反应发生率为0%，平均随访14±1.1个月后最终BCVA范围为20/20至20/80。
结论
MLF - AMT是治疗角膜真菌病期间处理角膜穿孔以避免急诊治疗性角膜移植的一种安全有效的选择。
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