J Cataract Refract Surg. 2021 Apr 1;47(4):552-555. doi: 10.1097/j.jcrs.0000000000000627.
A 17-year-old girl with a few years' history of declining vision, photophobia, and dry eye symptoms was referred to our clinic. She noted that the vision in the right eye declined significantly over the past several months. On her last year examination, her uncorrected distance visual acuity (UDVA) was recorded as 20/25 in both eyes with a corrected distance visual acuity (CDVA) of 20/20 in both eyes with minimal refractive error, with a diagnosis of bilateral Salzmann nodular degeneration. The patient was given artificial tears and was encouraged to wear sunglasses. On examination now, UDVA was 20/70 in the right eye and 20/40 in the left eye. The manifest refraction was -2.00 + 1.25 × 96 in the right eye and -1.00 + 2.00× 34 in the left eye, with a CDVA of 20/50 and 20/30, respectively. Slitlamp examination revealed superficial reticular stromal scar with clear intervening spaces involving the anterior 75 μm of the stromal cornea in the central 6.0 mm optical zone (Figure 1).JOURNAL/jcrs/04.03/02158034-202104000-00021/figure1/v/2021-04-19T183640Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202104000-00021/figure2/v/2021-04-19T183640Z/r/image-tiff The rest of the anterior and posterior segment examination was completely normal and noncontributory. Anterior segment optical coherence tomography (AS-OCT) revealed subepithelial lesion involving the central aspect of the cornea in the right eye more than that in the left eye (Figure 2). Family history was significant for an older sister with a similar problem who never required medical attention. She also has mild photophobia and dry eye symptoms. What is your differential diagnosis? What diagnostic test will help you in your diagnosis and clinical decision-making? What is the most likely diagnosis in this case? Do you recommend medical and/or surgical intervention in the right eye, realizing that there has been exacerbation of her ocular condition in the most recent year? What is the long-term prognosis and future plan for a patient with this potential condition?
一位 17 岁女孩，几年前开始出现视力下降、畏光和干眼症症状，被转介至我科就诊。她指出右眼视力在过去几个月内显著下降。去年检查时，双眼未矫正远视力（UDVA）分别为 20/25，矫正远视力（CDVA）分别为 20/20，屈光度最小，诊断为双侧 Salzmann 结节状变性。给予患者人工泪液并鼓励其佩戴太阳镜。此次就诊时，右眼 UDVA 为 20/70，左眼 UDVA 为 20/40。右眼的客观检影验光结果为-2.00+1.25×96，左眼为-1.00+2.00×34，相应的 CDVA 分别为 20/50 和 20/30。裂隙灯检查显示，在前部 75 μm 的角膜基质中，中央 6.0 mm 的光学区存在浅层网状基质瘢痕，其间有清晰的间隔（图 1）。
图 1
右眼中央 6.0 mm 光学区的前部和后部检查完全正常，无明显异常。眼前段光学相干断层扫描（AS-OCT）显示右眼中央角膜上皮下病变比左眼更明显（图 2）。家族史中，其姐姐也有类似问题，但从未接受过治疗，她也有轻度畏光和干眼症症状。
图 2
你的鉴别诊断是什么？哪种诊断性检查有助于你的诊断和临床决策？本例最可能的诊断是什么？鉴于该患者最近一年病情恶化，你是否建议对右眼进行药物和/或手术干预？对于这种潜在疾病患者的长期预后和未来计划是什么？
