Department of Ophthalmology, Mayo Clinic, Rochester, MN.
Cornea. 2021 Jul 1;40(7):907-909. doi: 10.1097/ICO.0000000000002604.
To describe the management and outcome of an ocular surface alkali burn in the setting of previous laser in situ keratomileusis (LASIK).
This is a case report and review of relevant literature.
A 25-year-old man with a history of LASIK presented 4 weeks after a sodium hydroxide splash to his left eye with visual acuity of 20/60 and a nonhealing epithelial defect adjacent to sectoral inferior limbal ischemia in the setting of trichiasis from upper eyelid cicatricial entropion. After topical corticosteroids were discontinued following the repair of the entropion, the patient returned 3 days later with worsening vision and severe diffuse lamellar keratitis with the melting of the LASIK flap. After promptly lifting the flap and debriding the interface, inflammation was managed with oral, instead of topical, corticosteroids. Over several weeks, the epithelium healed, and inflammation and interface edema resolved. At 10 years of follow-up, the patient had developed a localized pseudopterygium with mild corneal neovascularization but maintained 20/20 uncorrected visual acuity.
A chemical burn over a LASIK flap poses a challenge for managing corticosteroids, which are required to prevent diffuse lamellar keratitis but can also contribute to keratolysis beyond the first week after an alkali injury. Oral corticosteroid therapy may be beneficial in this situation, with a low threshold to lift the LASIK flap and debride the interface if inflammation occurs.
描述在先前的准分子激光原位角膜磨镶术（LASIK）背景下的眼表碱烧伤的处理和结果。
这是一份病例报告，并对相关文献进行了回顾。
一名 25 岁男性，LASIK 术后 4 周，左眼被氢氧化钠溅入，视力为 20/60，伴有下象限周边性角膜缘缺血区的未愈合上皮缺损，同时伴有由上眼睑瘢痕性内翻引起的三刺状睫毛。在修复内翻后停用局部皮质类固醇后，患者在 3 天后因视力下降和严重弥漫性层状角膜炎伴有 LASIK 瓣融解而返回。迅速掀起瓣并清创界面后，通过口服而不是局部给予皮质类固醇来控制炎症。数周后，上皮愈合，炎症和界面水肿消退。在 10 年的随访中，患者出现局部假性胬肉，伴有轻度角膜新生血管，但保持未经矫正的 20/20 视力。
LASIK 瓣上的化学烧伤在处理皮质类固醇方面带来挑战，皮质类固醇可预防弥漫性层状角膜炎，但也可能导致碱烧伤后第一周以外的角膜溶解。在这种情况下，口服皮质类固醇治疗可能有益，如果发生炎症，应毫不犹豫地掀起 LASIK 瓣并清创界面。
