Zhang Hao, Deng Yingping, Ma Ke, Sun Chengshu, Tang Jing
Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Front Med (Lausanne). 2022 Dec 21;9:1042405. doi: 10.3389/fmed.2022.1042405. eCollection 2022.
Deposits located between the Descemet memberane and the corneal endothelial layer in both eyes has not yet been reported after SMILE.
Grayish white fine deposits was found between the Descemet memberane and the corneal endothelial layer in both eyes of the patient's cornea, and no other abnormalities were observed in the anterior and posterior segments of patient's eyes with ophthalmic examination instrument. However, the visual acuity of patient remained unchanged. Significantly, the patient had a sister who had undergone the same procedure a year earlier without any complications. After careful questioning, we learned that the patient received the 9-valent human papillomavirus (HPV) vaccine on the third post-operative day without any other special experiences. We performed immunological examination and genetic testing on the patient. The results of immunological examination of patient showed no obvious abnormality, which was consistent with the routine trend after vaccination. In particular, a homozygous variation of the ARSG gene was found in the patient and her sister.
There are two possible causes of corneal changes in patients. The first is IGA elevation caused by vaccination, deposited in the cornea. Second, the ARSG gene mutation of the patient leads to a potential congenital corneal dystrophy, and clinical manifestations occur under the stimulation of the vaccine.
小切口基质透镜切除术（SMILE）后双眼Descemet膜与角膜内皮层之间出现沉积物的情况尚未见报道。
在患者双眼角膜的Descemet膜与角膜内皮层之间发现灰白色细微沉积物，使用眼科检查仪器检查患者眼的前段和后段未观察到其他异常。然而，患者的视力保持不变。值得注意的是，患者有一个姐姐一年前接受了相同手术，未出现任何并发症。经过仔细询问，我们了解到患者在术后第三天接种了9价人乳头瘤病毒（HPV）疫苗，没有其他特殊经历。我们对患者进行了免疫学检查和基因检测。患者的免疫学检查结果无明显异常，这与接种疫苗后的常规趋势一致。特别是，在患者及其姐姐中发现了ARSG基因的纯合变异。
患者角膜变化有两种可能原因。第一种是接种疫苗引起的免疫球蛋白A升高，沉积在角膜中。第二种是患者的ARSG基因突变导致潜在的先天性角膜营养不良，在疫苗刺激下出现临床表现。
