Eye Hospital of Wenzhou Medical University, 618 East Fengqi Road, 310000, Hangzhou, Zhejiang, China.
BMC Ophthalmol. 2022 Dec 16;22(1):495. doi: 10.1186/s12886-022-02712-4.
To report a case of a corneal endothelial ring after toric implantable collamer lens (TICL, V4C) implantation in the right eye of a patient.
A 36-year-old woman with refractive errors of -8.00 DS/-2.00 DC * 8° in the right eye and - 6.50 DS/-1.75 DC * 177° in the left eye developed a corneal endothelial ring in the right eye on the first day after receiving TICLs implantation for treatment of high myopic astigmatism, which has not been previously reported as a complication of ICLs implantation. At 1 day postoperatively, the uncorrected distance visual acuity (UDVA) was 20/16, the intraocular pressure as measured by non-contact tonometry was 16.9 mmHg, and the vault as measured by anterior segment optical coherence tomography was 1238 μm. The eye was quiet and there was no unusual anterior chamber reaction. However, slit-lamp examination revealed an endothelial annular lesion of approximately 0.4 mm in diameter in the central part of the cornea, which was gray-white in color. The shape of the ring was the same as that of the central hole of the TICL. Specular microscopy showed that the mean endothelial cell density (ECD) of the ring significantly decreased to 1442 ± 263 cells/mm, while the other part was still normal (2852 ± 103 cells/mm). After 9 days of corticosteroid treatment and intense lubrication, the patient had a clear cornea, increased ECD (1532 ± 653 cells/mm), and a good UDVA (20/16).
This case suggests that a few hours after ICL V4C implantation, with a large vault, corneal displacement caused by an air puff would make the endothelium close to or even contact the ICL, producing a corneal endothelial ring. After ruling out various possible factors, we speculated that the endothelial ring was developed due to the non-contact tonometer air puff before slit-lamp evaluation, and this phenomenon was recorded by Corvis, which confirmed that the cornea could come in contact with the ICL due to gas shock. This "contact" may cause transient corneal endothelial damage.
报告一例右眼行 toric 可植入 Collamer 透镜（TICL，V4C）植入术后出现角膜内皮环的病例。
一名 36 岁女性，右眼近视散光 -8.00DS/-2.00DC8°，左眼近视散光 -6.50DS/-1.75DC177°，行 TICL 植入术治疗高度近视散光，术后第一天右眼出现角膜内皮环，此前尚未报道 ICL 植入术后出现该并发症。术后 1 天，右眼未矫正远视力（UDVA）为 20/16，非接触眼压计测量的眼压为 16.9mmHg，眼前节光学相干断层扫描（AS-OCT）测量的拱高为 1238μm。眼部安静，无前房反应异常。但裂隙灯检查发现角膜中央约 0.4mm 直径的内皮环形病变，呈灰白色。环的形状与 TICL 的中央孔相同。共焦显微镜显示，环处的平均内皮细胞密度（ECD）显著下降至 1442±263 个/ mm2，而其他部位仍正常（2852±103 个/ mm2）。经 9 天糖皮质激素治疗和加强润滑后，患者角膜透明，ECD 增加（1532±653 个/ mm2），UDVA 良好（20/16）。
本例提示 ICL V4C 植入后数小时，因眼压高、角膜膨隆，角膜内皮可能接触或接近 ICL，导致角膜内皮环形成。排除各种可能因素后，推测内皮环是由于裂隙灯检查前非接触眼压计的空气脉冲引起的，该现象被 Corvis 记录，证实角膜可因气体冲击而接触 ICL。这种“接触”可能导致短暂的角膜内皮损伤。
