Moshirfar Majid, Wang Victoria M, Moin Kayvon A, Hoopes Phillip C
Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA.
John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.
Clin Ophthalmol. 2024 Dec 25;18:3925-3934. doi: 10.2147/OPTH.S497690. eCollection 2024.
Anorexia nervosa (AN) is a psychiatric eating disorder characterized by body mass index (BMI) ≤ 18.5, fear of gaining weight, and a distorted perception of body weight. With increasing rates of myopia, there is a population of patients who concurrently develop AN and may seek corneal refractive surgery. This study reviews the ophthalmic manifestations of AN and provides preliminary guidelines for patients with AN undergoing corneal refractive surgery. The literature search was conducted through the PubMed, Scopus, and Ovid databases through June 2, 2024, for publications detailing the ocular manifestations of AN. These findings were then considered in the context of potential complications after corneal refractive surgery, and preoperative guidelines for patients with AN were formulated. Twelve articles described a total of 114 patients with AN (227 eyes) with ophthalmic manifestations. Among the studied eyes, 14% had ocular surface abnormalities, 5% had cataracts/visual disturbances, 64% had posterior segment abnormalities, and 20% had orbital/neurological abnormalities. Various ophthalmic findings of AN may increase the risk of delayed corneal wound healing, ocular surface dryness, perioperative bleeding, flap-related complications, and poor visual outcomes after corneal refractive surgery. The BMI of patients suspected with AN must be assessed, and patients should be screened for diagnosis of AN. If mildly and moderately underweight patients with AN have normal ophthalmic and medical workups, they may proceed with a typical preoperative workup for corneal refractive surgery. Ultimately, the decision to recommend elective corneal refractive surgery for these patients rests with the surgeon. This study should be considered a foundation for future research, encouraging collaboration across medical disciplines to develop more comprehensive guidelines for managing this patient population.
神经性厌食症（AN）是一种精神性饮食失调症，其特征为体重指数（BMI）≤18.5、害怕体重增加以及对体重的认知扭曲。随着近视率的上升，有一部分同时患有AN的患者可能会寻求角膜屈光手术。本研究回顾了AN的眼科表现，并为接受角膜屈光手术的AN患者提供初步指导原则。通过检索截至2024年6月2日的PubMed、Scopus和Ovid数据库，查找详细描述AN眼部表现的出版物。然后结合角膜屈光手术后的潜在并发症来考量这些发现，并制定针对AN患者的术前指导原则。12篇文章共描述了114例有眼科表现的AN患者（227只眼）。在所研究的眼睛中，14%有眼表异常，5%有白内障/视觉障碍，64%有眼后段异常，20%有眼眶/神经异常。AN的各种眼科表现可能会增加角膜伤口愈合延迟、眼表干燥、围手术期出血、瓣相关并发症以及角膜屈光手术后视力不佳的风险。必须评估疑似患有AN患者的BMI，并对患者进行AN诊断筛查。如果轻度和中度体重过轻的AN患者眼科和医学检查结果正常，他们可以进行典型的角膜屈光手术术前检查。最终，为这些患者推荐择期角膜屈光手术的决定权在外科医生手中。本研究应被视为未来研究的基础，鼓励跨医学学科合作，为管理这一患者群体制定更全面的指导原则。
