Yang Kaili, Fan Qi, Xu Liyan, Gu Yuwei, Pang Chenjiu, Ren Shengwei
Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China.
Front Bioeng Biotechnol. 2023 Jun 2;11:1181117. doi: 10.3389/fbioe.2023.1181117. eCollection 2023.
Patients with unilateral post-LASIK keratectasia (KE) have clinical ectasia in one eye but not in the fellow eye. As serious complications, these cases are rarely reported but are worth investigating. This study aimed to explore the characteristics of unilateral KE and the accuracy of corneal tomographic and biomechanical parameters to detect KE and distinguish fellow eyes from control eyes. The study analyzed 23 KE eyes, 23 KE fellow eyes, and 48 normal eyes from age- and sex-matched patients who had undergone LASIK. The Kruskal-Wallis test and further paired comparisons were performed to compare the clinical measurements of the three groups. The receiver operating characteristic curve was used to evaluate the ability to distinguish KE and fellow eyes from the control eyes. Binary logistic regression with the forward stepwise method was performed to produce a combined index, and the DeLong test was used to compare the discriminability difference of the parameters. Males accounted for 69.6% of patients with unilateral KE. The duration between corneal surgery and the onset of ectasia ranged from 4 months to 18 years, with a median time of 10 years. The KE fellow eye had a higher posterior evaluation (PE) value than the control eyes (5 vs. 2, = 0.035). Diagnostic tests showed that PE, posterior radius of curvature (3 mm), anterior evaluation (FE), and Corvis biomechanical index-laser vision correction (CBI-LVC) were sensitive indicators for distinguishing KE in the control eyes. The ability of PE to detect the KE fellow eye from the control eye was 0.745 (0.628 and 0.841), with 73.91% sensitivity and 68.75% specificity at a cut-off value of 3. The ability of a combined index, constructed using PE and FE, to distinguish fellow eyes of KE from controls was 0.831 (0.723 and 0.909), which was higher than that of PE and FE individually ( < 0.05). The fellow eyes of patients with unilateral KE had significantly higher PE values than control eyes, and a combination of PE and FE enhanced this differentiation in a Chinese population. More attention should be paid to the long-term follow-up of patients after LASIK and to be wary of the occurrence of early KE.
准分子激光原位角膜磨镶术（LASIK）后单侧角膜扩张（KE）患者的一只眼睛出现临床角膜扩张，而另一只眼睛未出现。作为严重并发症，此类病例鲜有报道，但值得研究。本研究旨在探讨单侧KE的特征，以及角膜断层扫描和生物力学参数检测KE并区分对侧眼与对照眼的准确性。该研究分析了接受LASIK手术的年龄和性别匹配患者的23只KE眼、23只KE对侧眼和48只正常眼。采用Kruskal-Wallis检验及进一步的配对比较来比较三组的临床测量值。采用受试者工作特征曲线评估区分KE眼和对侧眼与对照眼的能力。采用向前逐步法进行二元逻辑回归以生成综合指标，并使用DeLong检验比较参数的判别差异。男性占单侧KE患者的69.6%。角膜手术至角膜扩张发作的时间为4个月至18年，中位时间为10年。KE对侧眼的后表面评估（PE）值高于对照眼（5比2，P = 0.035）。诊断试验表明，PE、3mm后表面曲率半径、前表面评估（FE）和Corvis生物力学指数-激光视力矫正（CBI-LVC）是区分对照眼中KE的敏感指标。PE从对照眼中检测KE对侧眼的能力为0.745（0.628和0.841），在截断值为3时，灵敏度为73.91%，特异度为68.75%。使用PE和FE构建的综合指标区分KE对侧眼与对照眼的能力为0.831（0.723和0.909），高于单独使用PE和FE的能力（P < 0.05）。单侧KE患者的对侧眼PE值显著高于对照眼，在中国人群中，PE和FE的组合增强了这种区分能力。应更加关注LASIK术后患者的长期随访，并警惕早期KE的发生。
