Motwani Manoj, Agu Emmanuel, Xu Albert, Yung Madeline
Motwani Lasik Institute/Cornea Revolution, San Diego, CA, USA.
Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.
Int Med Case Rep J. 2025 Jan 15;18:91-98. doi: 10.2147/IMCRJ.S476407. eCollection 2025.
To compare the outcomes of two different surgical planning strategies for topography-guided repair of post-LASIK ectasia.
This is a case report of a patient presenting with post-LASIK ectasia. A retrospective chart review was used to collect details of the ophthalmic exam, as well as ocular imaging such as anterior segment optical coherence tomography and Scheimpflug corneal tomography. Treatment planning was performed initially with the Phorcides analytical engine, and then an enhancement was performed with the LYRA/San Diego Protocol. Epithelium-off corneal cross-linking was performed at 3.0 mW/cm for 30 minutes.
The patient initially presented with a remote history of LASIK and progressive left eye blurring. His uncorrected distance visual acuity (UDVA) was 20/40, with a corrected distance visual acuity (CDVA) of 20/25 with a manifest refraction of -1.25 +1.75 × 180. His central corneal thickness was 529 μm, and corneal topography/tomography demonstrated inferior steepening of the left eye consistent with post-LASIK ectasia. He underwent simultaneous PRK and epithelium-off corneal cross-linking with a treatment plan by Phorcides of -0.14 -0.87 × 001. His vision stabilized at post-operative month 7 to a UDVA 20/40, CDVA 20/20, and manifest refraction of -2.75 +3.50 × 005. He underwent PRK enhancement with a treatment plan by the San Diego Protocol of +0.00 -1.15 × 094, with an outcome of UDVA 20/20, CDVA 20/20, and manifest refraction of -1.00 +0.75 × 174.
The LYRA/San Diego Protocol outperformed Phorcides in a case of corneal ectasia. With appropriate planning, patients with irregular corneas can achieve excellent refractive outcomes.
比较两种不同手术规划策略用于准分子激光原位角膜磨镶术（LASIK）后角膜扩张的地形图引导修复的效果。
这是一例LASIK后角膜扩张患者的病例报告。通过回顾性病历审查收集眼科检查细节以及眼前节光学相干断层扫描和角膜Scheimpflug断层扫描等眼部成像资料。最初使用Phorcides分析引擎进行治疗规划，然后采用LYRA/圣地亚哥方案进行强化。在3.0 mW/cm下进行30分钟的去上皮角膜交联。
该患者最初有LASIK远期病史且左眼渐进性模糊。其未矫正远视力（UDVA）为20/40，矫正远视力（CDVA）为20/25，明显屈光不正为-1.25 +1.75×180。他的中央角膜厚度为529μm，角膜地形图/断层扫描显示左眼下方变陡，符合LASIK后角膜扩张。他接受了准分子激光角膜表面切削术（PRK）和去上皮角膜交联联合治疗，Phorcides制定的治疗方案为-0.14 -0.87×001。术后7个月时其视力稳定，UDVA为20/40，CDVA为20/20，明显屈光不正为-2.75 +3.50×005。他采用圣地亚哥方案进行了PRK强化治疗，治疗方案为+0.00 -1.15×094，结果为UDVA 20/20，CDVA 20/20，明显屈光不正为-1.00 +0.75×174。
在角膜扩张病例中，LYRA/圣地亚哥方案优于Phorcides。通过适当规划，不规则角膜患者可获得良好的屈光效果。
