Carranza-Casas Mario, Anaya-Barragán Fabiola, Cedillo Gabriel, Graue-Hernández Enrique O, Navas Alejandro
Department of Cornea, Institute of Ophthalmology "Conde de Valenciana", Mexico City, Mexico.
Am J Ophthalmol Case Rep. 2022 Jan 28;25:101270. doi: 10.1016/j.ajoc.2022.101270. eCollection 2022 Mar.
This report details a case of an unusual late dislocation of a laser in situ keratomileusis (LASIK) flap due to animal-related trauma 16 years after the initial surgery.
A 59-year-old woman with history of LASIK surgery on both eyes 16 years prior, and uncomplicated cataract surgery on the left eye (oculus sinister; OS) 3 years prior, arrived at our institution with sudden painful visual loss 3 hours after receiving a scratch on OS from her dog. Corneal examination revealed a completely displaced nasally hinged LASIK flap folded irregularly over the hinge, with multiple creases over its entire thickness. The flap was intact but edematous and opaque, with detritus present both on the flap surface and stromal face. Treatment was initiated with topical moxifloxacin and oral clindamycin. The next morning, the flap was refloated, and debris was removed from both sides of the flap while irrigating with preservative-free moxifloxacin. The flap was repositioned and a bandage contact lens placed. Postoperative topical medication included moxifloxacin, prednisolone acetate, and sodium hyaluronate. At the final follow-up visit, the patient was asymptomatic, with a measured uncorrected distance visual acuity (UDVA) of 20/25 OS.
This uncommon case highlights the longest reported interval-16 years- between initial surgery and traumatic LASIK flap displacement, caused by animal-related trauma. Patients experiencing LASIK surgery complications, including contaminated trauma many years after the original ablation, can still recover excellent visual acuity when managed appropriately and in a timely fashion.
本报告详细介绍了一例因动物相关创伤导致准分子原位角膜磨镶术（LASIK）瓣在初次手术后16年发生罕见晚期脱位的病例。
一名59岁女性，16年前双眼接受过LASIK手术，3年前左眼（左眼；OS）接受过无并发症的白内障手术，在被其宠物狗抓伤左眼3小时后，因突发疼痛性视力丧失前来我院就诊。角膜检查发现，一个完全移位的鼻侧铰链式LASIK瓣在铰链上方不规则折叠，整个厚度上有多处褶皱。瓣片完整，但水肿且不透明，瓣片表面和基质面均有碎屑。开始局部使用莫西沙星和口服克林霉素进行治疗。第二天早上，将瓣片重新漂浮，在使用无防腐剂的莫西沙星冲洗的同时，从瓣片两侧清除碎屑。将瓣片重新定位并放置绷带隐形眼镜。术后局部用药包括莫西沙星、醋酸泼尼松龙和透明质酸钠。在最后一次随访时，患者无症状，左眼测量的未矫正远视力（UDVA）为20/25。
这一罕见病例突出了初次手术与因动物相关创伤导致的创伤性LASIK瓣移位之间报告的最长间隔时间——16年。经历LASIK手术并发症的患者，包括在最初消融多年后发生的污染性创伤，在得到适当及时的处理后仍可恢复极佳的视力。
