Meyer J C, Stulting R D, Thompson K P, Durrie D S
Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 30322, USA.
Am J Ophthalmol. 1996 May;121(5):529-39. doi: 10.1016/s0002-9394(14)75427-3.
We studied the occurrence of late scarring after photorefractive keratectomy and its response to topical corticosteroids and debridement during the course of follow-up of 950 eyes that had photorefractive keratectomy with excimer laser.
Five eyes of four patients developed localized corneal scars, decreased visual acuity, and increased myopia after five to 33 months of good visual acuity, with trace haze. In two eyes, scars were removed by debridement alone. In these two eyes, recurrent scars were treated by debridement, followed by aggressive treatment with topical corticosteroids. Two other eyes were treated with topical corticosteroids alone. The fifth eye, which developed a scar after debridement to correct a subjective visual distortion after photorefractive keratectomy, was treated with debridement followed by aggressive topical corticosteroids.
Treatment with topical corticosteroids alone in two eyes improved uncorrected visual acuity slightly and decreased myopia, although the scars remained unchanged. Debridement without aggressive topical corticosteroid use resulted in rapid return of the scars and a decrease in visual acuity. Subsequent debridement after aggressive topical corticosteroid treatment resulted in resolution of scars and no recurrence after discontinuation of corticosteroids in one case. In another case, the scar recurred eight months after discontinuation of topical corticosteroids. In Case 4, the scar has not recurred as the topical corticosteroid dosage has been reduced.
Patients who undergo photorefractive keratectomy should be counseled concerning the risk of late scarring, reexamined frequently after photorefractive keratectomy, and treated with topical corticosteroids after corneal trauma. Long-term treatment with topical corticosteroids may be required to prevent the recurrence of scars after debridement.
我们在950只接受准分子激光屈光性角膜切削术的眼睛的随访过程中，研究了屈光性角膜切削术后晚期瘢痕形成的情况及其对局部使用皮质类固醇和清创术的反应。
4例患者的5只眼睛在视力良好且有微量 haze 的5至33个月后，出现局部角膜瘢痕、视力下降和近视增加。在2只眼中，仅通过清创术去除了瘢痕。在这2只眼中，复发性瘢痕先通过清创术治疗，然后积极局部使用皮质类固醇。另外2只眼仅接受局部皮质类固醇治疗。第5只眼在屈光性角膜切削术后为纠正主观视觉扭曲而进行清创术后出现瘢痕，先进行清创术，然后积极局部使用皮质类固醇治疗。
2只仅接受局部皮质类固醇治疗的眼睛，未矫正视力略有改善，近视度数降低，尽管瘢痕未改变。未积极局部使用皮质类固醇的清创术导致瘢痕迅速复发，视力下降。在1例中，积极局部使用皮质类固醇治疗后随后进行清创术，瘢痕消退，停用皮质类固醇后未复发。在另一例中，停用局部皮质类固醇8个月后瘢痕复发。在病例4中，随着局部皮质类固醇剂量的减少，瘢痕未复发。
应向接受屈光性角膜切削术的患者告知晚期瘢痕形成的风险，屈光性角膜切削术后应频繁复查，角膜创伤后应局部使用皮质类固醇治疗。可能需要长期局部使用皮质类固醇以防止清创术后瘢痕复发。
