Nouzovská Kateřina, Noveyri Behzad Barazandeh, Abu-Mustafa Sabat, Alió Jorge L
Research and Development, Vissum (Miranza Group), Alicante, Spain.
Department of Ophthalmology, University Hospital, Hradec Králové, Czech Republic.
Cornea. 2024 Nov 7;44(6):779-787. doi: 10.1097/ICO.0000000000003754.
The purpose of this study was to describe 5 cases (10 eyes) that, following purely cosmetic femtosecond laser-assisted keratopigmentation (KTP), showed evolution toward corneal ectasia during a variable postoperative period.
In a case series, 5 patients after bilateral purely cosmetic KTP showed progressive changes in topographic, refractive, and even in visual performance values manifesting from 6 months to 4 years following the procedure. A femtosecond laser-assisted cosmetic intrastromal KTP technique was performed in all patients using micronized mineral pigments. Two patients underwent a retouch using superficial automated KTP to optimize cosmetic outcome.
All patients preoperatively demonstrated normal corneal topography with no intraocular pathology and unimpaired visual acuity. One of the cases developed corneal ectasia after magnetic resonance imaging, another confirmed intensive eye rubbing due to allergic conjunctivitis, and 1 patient underwent previous myopic laser in situ keratomileusis procedure. The rest did not show any preoperative clinical evidence potentially related to the development of the keratectasia. One case rather demonstrated modification of keratometry (K) values than a clear corneal ectasia. Three cases were treated with epi-off corneal cross-linking.
Corneal ectasia is a potential complication after cosmetic KTP and should be included in the preoperative informed consent. A comprehensive preoperative screening is necessary to exclude suspicious cases, and patients should be instructed to avoid eye rubbing and other maneuvers that could affect the potential development of this complication.
本研究旨在描述5例（10只眼）在单纯美容性飞秒激光角膜色素沉着术（KTP）后，在不同术后时期出现角膜扩张进展的病例。
在一个病例系列中，5例双侧单纯美容性KTP术后患者在术后6个月至4年期间，出现了地形学、屈光甚至视觉性能值的渐进性变化。所有患者均采用微粉化矿物色素进行飞秒激光辅助美容性基质内KTP技术。2例患者接受了表层自动KTP修补以优化美容效果。
所有患者术前角膜地形图均正常，无眼内病变，视力未受损。其中1例在磁共振成像后出现角膜扩张，另1例因过敏性结膜炎证实有强烈的揉眼行为，1例患者曾接受过近视激光原位角膜磨镶术。其余患者术前未显示任何可能与角膜扩张发展相关的临床证据。1例患者表现为角膜曲率（K）值改变，而非明显的角膜扩张。3例患者接受了上皮下角膜交联治疗。
角膜扩张是美容性KTP术后的一种潜在并发症，应纳入术前知情同意书中。术前进行全面筛查以排除可疑病例是必要的，并且应指导患者避免揉眼和其他可能影响该并发症潜在发展的行为。
