Ward M A, Artunduaga G, Thompson K P, Wilson L A, Stulting R D
CLAO J. 1995 Apr;21(2):130-2.
The management of keratoconus with contact lenses may be complicated by punctate epithelial keratopathy, epithelial breakdown, and nodular, raised subepithelial scars. We report four consecutive cases of contact lens intolerance due to pain in patients with keratoconus and raised, nodular scars. Excimer laser phototherapeutic keratectomy (PTK) was used to treat all patients. Follow-up ranged from 7 to 14 months (mean: 10 months). All patients resumed rigid gas permeable (RGP) contact lens wear 2 to 4 weeks after surgery. Visual acuities ranged from 20/40 to 20/70 before surgery and improved to 20/25 or better in all patients postoperatively. PTK flattened the central cornea by an average of 5.43 D (range: 1.13-10.19 D); and refractive cylinder was reduced an average of 4.00 D (range: 3.25-5.25 D). We conclude that PTK may delay or avoid penetrating keratoplasty in selected patients with keratoconus who are contact lens intolerant due to nodular subepithelial scars.
圆锥角膜患者使用角膜接触镜进行治疗时，可能会出现点状上皮性角膜病变、上皮破损以及结节状、隆起的上皮下瘢痕等并发症。我们报告了4例因圆锥角膜患者出现疼痛且伴有隆起的结节状瘢痕而导致角膜接触镜不耐受的连续病例。所有患者均采用准分子激光角膜切削术（PTK）进行治疗。随访时间为7至14个月（平均10个月）。所有患者术后2至4周恢复佩戴硬性透气性（RGP）角膜接触镜。术前视力范围为20/40至20/70，术后所有患者视力均提高到20/25或更好。PTK使中央角膜平均变平5.43 D（范围：1.13 - 10.19 D）；屈光柱镜平均降低4.00 D（范围：3.25 - 5.25 D）。我们得出结论，对于因结节状上皮下瘢痕导致角膜接触镜不耐受的特定圆锥角膜患者，PTK可能会延迟或避免穿透性角膜移植术。
