Reichel M B, Busin M, Koch F, Sekundo W
Universitäts-Augenklinik Bonn.
Klin Monbl Augenheilkd. 1995 Apr;206(4):266-7. doi: 10.1055/s-2008-1035437.
Severe complications such as a traumatic wound dehiscence have been described very rarely after radial keratotomy. The following case demonstrates for the first time that wound healing is not completed even 31/2 years postoperatively and that therefore an ocular blunt trauma may still cause a dehiscence of the radial incisions.
A 22-year-old patient presented in July 1993 to our emergency unit because of a corneal perforation in his right eye after a blunt trauma. His past medical history was significant for radial keratotomy surgery performed in January 1990 to correct a bilateral low-degree myopia (OD = -3.25 D; OS = -3.75 D). At surgery a horizontal rupture running through the entire cornea and including the two radial keratotomies at the 3 and 9 o'clock position was evident. The whole iris and lens were missing. The retina was completely detached. The corneal laceration was sutured. Twelve days later the retina was reattached with an encircling band, vitrectomy, endolaser and cryocoagulation, as well as silicone oil fill. Finally, a penetrating keratoplasty was performed 6 months after the accident. Thereafter, visual acuity improved to 0.1. The histologic examination of the corneal button showed that the wound healing of the incisions that had remained intact was not completed yet. Epithelial plugs of various size were still filling the somewhat dehiscent wound margins. Fibroblastic activity was detected in the surrounding stroma.
Even several years after surgery, blunt traumas represent a definite risk for eyes undergoing radial keratotomy.
放射状角膜切开术后极少出现如外伤性伤口裂开等严重并发症。以下病例首次证明，即使在术后3年半伤口愈合仍未完成，因此眼部钝挫伤仍可能导致放射状切口裂开。
一名22岁患者于1993年7月因右眼钝挫伤后角膜穿孔前来我院急诊。他的既往病史中，1990年1月曾行放射状角膜切开术以矫正双眼低度近视（右眼=-3.25D；左眼=-3.75D）。手术中可见一条水平破裂口贯穿整个角膜，包括3点和9点位置的两条放射状角膜切口。整个虹膜和晶状体缺失。视网膜完全脱离。角膜裂伤进行了缝合。12天后，通过环扎带、玻璃体切除术、眼内激光和冷冻凝固以及硅油填充使视网膜复位。最终，在事故发生6个月后进行了穿透性角膜移植术。此后，视力提高到0.1。角膜植片的组织学检查显示，未裂开的切口伤口愈合仍未完成。各种大小的上皮栓仍填充在稍有裂开的伤口边缘。在周围基质中检测到成纤维细胞活性。
即使在手术后数年，钝挫伤对于接受放射状角膜切开术的眼睛仍是明确的风险。
