LASIK术后角膜扩张一例

患者,男,23岁。近视11年持续戴镜,佩戴角膜接触镜6年,脱镜14d。现戴镜度数:双眼均-950度。2003年11月19日于我院行双眼LASIK治疗。术前散瞳验光:右眼-9.75DS-0.75DC×165°=1.5,左眼-9.75DS-0.50DC×5°=1.5。角膜曲率:右眼43.4×77°,42.4×167°,左眼43.6×81°,42.8×171°。眼轴长度:右眼26.49mm,左眼25.90mm。角膜厚度:右眼562μm,左眼560μm。角膜直径:右眼11.50mm,左眼11.50mm。眼压:右眼18mmHg(1mmHg=0.133kPa),左眼17mmHg。术前角膜地形图未见异常。术中右眼实际矫正度数:-11.75DS-0.75DC×165°,角膜瓣厚度160μm,切削深…     

LASIK术后继发性圆锥角膜1例

患者，男，45岁。因左眼LASIK术后9年、视力下降8年到我院就诊。患者既往双眼高度近视，1996年在外院行左眼LASIK术，右眼因并发性白内障未行LASIK手术，术后左眼视力0．5，1年后左眼视力开始逐渐下降，2004年4月在外院检查左眼视力为0．03，矫正0．2，角膜地形图检查右眼角膜中央厚度为611μm，屈光度43．84D，角膜前表面屈光度42．4D，后表面屈光度50．8D，最大拟似角膜计值（SimK）43．8D，最小SimK值42．9D；左眼角膜中央厚度为339p．m，屈光度52．87D，角膜前表面屈光度43．0D，后表面屈光度58．3D，最大SimK值53．6D，最小SimK值50．2D。诊断为左眼继发性圆锥角膜，予配戴硬性角膜接触镜治疗。2005年8月来我院就诊，查体：VODFC／30cm，不能矫正，VOS0．06，矫正-16．0 DS=0．3，右眼角膜透明，晶状体核性及后囊下混浊。     

LASIk术中角膜瓣上皮剥脱伴撕裂一例

闫××男34岁双眼视力下降25y,曾戴角膜接触镜1y,脱镜10y,无其它眼部及全身病史。双眼视力均为0.05。散瞳验光,右眼-10.5DS-1.75DC×10°=0.8左眼-9.5DS-2.0DC×175°=0.8。患者双眼前节及眼底未见异常。角膜厚度:右眼613μm,左眼610μm。眼压:右眼16mmHg,左眼15mmHg。角膜地形图检查:右眼VK46.17,HK45.12CK46.68;左眼VK45.94,HK45.16CK46.66。于2005年7月17日双眼行准分子原位角膜磨镶术。使用Moria CB(130)旋转式微型角膜刀制作角膜瓣。先行右眼手术,术前5min给予倍诺喜眼水点眼3次,制瓣完毕即发现角膜上皮呈片状剥脱、肿胀,部…     

PTK联合PRK治疗LASEK术后病毒性角膜炎致角膜白斑1例

患者男性,36岁。于2011年4月8日在我院行双眼激光上皮下角膜磨镶术﹙laser subepithelial keratomileusis,LASEK﹚,术前近视右眼:-6.25 DS/-0.50 DC×30°矫正1.0;左眼:-6.50/-0.50×145矫正1.0。A超查角膜中央厚度:右眼487μm,左眼491μm。术前眼压:右眼17 mmHg;左眼16 mm Hg。术后常规用典必殊滴眼液qid,爱丽滴眼液     

LASIK术后层间沙漠反应再手术1例

患者女,26岁。因双眼近视来我院要求手术。全身状况良好。双眼远视力0.08,近视力1.5,散瞳等综合验光为：右眼-4.50DS→1.0,左眼-3.73DS -1.00DC×173°→1.0。角膜地形图检查为正常对称哑铃状,眼轴长均24.3 mm,中央角膜厚度右535μm,左541μm,眼压、眼底等检查均正常。诊断：右眼单纯性近视,左眼复性近视。于2004年4月25日行双眼LASIK手术,术中顺利。术后第1天视力,右眼     

CIRCLE治疗飞秒激光小切口角膜基质透镜取出术后欠矫3例

<正>资料病例1：女性,32岁。2019年7月因双眼屈光不正行双眼飞秒激光小切口角膜基质透镜取出术(femtosecond laser small incision lenticule extraction, SMILE)。术前屈光度：右眼-6.25 DS/-0.75 DC×20°,左眼-6.25 DS/-0.75 DC×165°,术前双眼最佳矫正视力均为1.0。双眼角膜地形图正常,角膜厚度：右眼535μm,左眼532μm。术前眼压(NCT)：右眼16.0 mmHg (1 mmHg=0.133 kPa),左眼18.0 mmHg。SMILE术后1 d检查视力：右眼0.5,左眼0.8。术后10 d视力：右眼0.5,检影验光-0.75 D,矫正1.0;左眼1.0,验光无屈光度。     

成人屈光参差性弱视准分子激光原位磨镶术后视力改善1例

1病例报告女,19岁,因双眼视物模糊,拟行准分子激光手术,术前行眼压,眼底,角膜地形图,角膜测厚(角膜中央厚度右眼531μm,左眼529μm),眼轴测量,无明显手术禁忌,手术前主觉验光,右眼:0.1-8.00D S→0.8,左眼:0.06-12.00D S→0.6,散瞳后电脑及插片验光,右眼:0.1-8.00DS/0.50D S×17     

穿透性角膜移植治疗LASIK术后继发圆锥角膜

目的 观察穿透性角膜移植治疗准分子激光原位角膜磨削术(Laserin situkeratomileusis,LASIK)术后继发圆锥角膜的效果.方法 对6例LASIK术后确诊为继发圆锥角膜的患者进行穿透性角膜移植术,选用直径7～7.5mm植片,与植床等大.术后随访1～5年,观察和评价其疗效.结果 本研究6例患者LASIK术前角膜厚度平均为394.9μm.术后圆锥发生时间(13±3.4)个月,穿透性角膜移植术后,中央角膜厚度平均为504.7μm,视力明显增进,随访期内未见圆锥角膜复发.讨论我们建议,进行LASIK对术中切削时,角膜基质床的厚度不应小于270μm,角膜总厚度不应小于400μm.对LASIK术后继发圆锥角膜患者行穿透性角膜移植术,植床直径与角膜植片等大,术后再选择性拆除缝线,将有助于降低术后免疫排斥反应发生率和圆锥复发,减少手术源性散光,提高视力.     

有晶状体眼后房型人工晶状体植入术治疗二次LASIK 手术后屈光回退一例

患者，男，48 岁，因“ 二次准分子激光原位角膜磨镶术（LASIK）术后6年，视力下降3年”来我院就诊。患者首次于2010 年5 月18 日就诊于青岛华厦眼科医院，因高度近视预行LASIK手术。术前检查：右眼视力0.06，左眼0.15；右眼眼压20 mmHg（1 mmHg=0.133 kPa），左眼 21 mmHg；右眼散瞳验光-14.00-1.50×175=0.8，左眼-6.00-0.50×170=1.2；右眼角膜曲率43.25/44.50×80，左眼 43.75/43.75×90；右眼眼轴长度 30.76 mm，左眼 26.58 mm；右眼角膜厚度575 μm，左眼577 μm。患者术后 1 d复诊，右眼视力0.8，左眼1.2。术后4个月复诊，右眼视力0.15，左眼1.2+ ；右眼综合验光-3.00-1.25×160=0.8+ ，左眼1.2。术后1年7个月复诊，右眼视力0.12，左眼0.8；右眼角膜厚度436 μm，左眼450 μm；右眼眼轴长度30.81 mm，左眼25.98 mm；右眼综合验光-4.50-0.75×180=0.8，左眼 1.2。诊断为LASIK术后屈光回退。     

两种显微角膜板层刀制作角膜瓣厚度的对比分析

目的:对Hansatome自动旋转式显微角膜刀及AmadeusⅡ自动平推式显微角膜刀制作准分子激光原位角膜磨镶术(LASIK)角膜瓣厚度进行对比分析。方法:对来我院行LASIK的患者50例100眼,随机分成两组,一组用Hansatome显微角膜刀160μm刀头制作角膜瓣,另一组用AmadeusⅡ显微角膜刀140μm刀头制作角膜瓣。对所有患者进行术前中央角膜厚度测量及术中角膜基质床厚度测量,从而计算角膜瓣厚度。所有的患者均先行右眼手术再行左眼。对两组患者实际切削的角膜瓣厚度进行对比,同时对两种显微角膜板层刀制作角膜瓣厚度左右眼之间进行对比分析。结果:Hansatome组实际角膜瓣厚度67～158(平均98.70±18.04)μm;AmadeusⅡ组实际角膜瓣厚度69～171(平均110.60±16.47)μm,两种角膜刀制作角膜瓣厚度差异有统计学意义(P=0.001)。Hansatome组右眼104.40±18.78μm,左眼93.00±15.61μm,两眼角膜瓣厚度差异有统计学意义(P=0.01);AmadeusⅡ组右眼115.12±18.74μm,左眼105.20±12.29μm,P=0.024,患者左眼角膜瓣均比右眼要薄,差异有统计学意义。结论:在LASIK术中角膜板层刀制作的角膜瓣厚度与预计值有一定的偏差,术中测量角膜瓣厚度有重要的参考价值。     

Early onset ectasia following laser in situ keratomileusus: case report and literature review

PURPOSE: Laser in situ keratomileusis (LASIK) has been associated with the development of postoperative corneal ectasia. We present a case of early onset ectasia after LASIK, review known risk factors in development, and discuss possible strategies for prevention. METHODS: A 39-year-old man underwent bilateral LASIK for moderate myopia. Preoperative cycloplegic refractions were -9.00 + 0.25 x 140 degrees OD and -7.75 sphere OS. Corneal topography demonstrated mild inferior steepening bilaterally although definite evidence of keratoconus by either the Klyce/Maeda and Smolek/Klyce keratoconus screening tests was not present. Following the creation of flaps with 160-microm plates, ablations of 93 microm OD and 80 microm OS were performed, estimated to leave residual stromal beds of at least 314 microm OD and 330 microm OS. RESULTS: On the first postoperative day, uncorrected visual acuities were 20/400 OD and 20/40 OS. On the fifth postoperative day, the patient's uncorrected visual acuity was 20/400 OD, and 20/300 OS. Corneal topography of the right eye showed profound inferior steepening with an apical corneal power in excess of 57 D; topography of the left eye showed mild inferior steepening. Eighteen months after surgery best corrected visual acuity was 20/40 OD and 20/30 OS with rigid gas permeable contact lenses. CONCLUSIONS: This case highlights the need for a high index of suspicion when one notes an asymmetric bow-tie pattern on preoperative LASIK corneal topography, despite seemingly safe estimates of residual stromal bed thickness.     

Late bilateral keratectasia after LASIK in a low myopic patient

PURPOSE: To report a rare case of late bilateral ectasia developing after LASIK for low myopia without preoperative risk factors. METHODS: A 21-year-old man underwent bilateral uneventful LASIK for low myopia of -2.75 diopters in both eyes. Preoperative corneal pachymetry was 531 microm in the right eye and 526 microm in the left eye. The total ablation depth was 46.8 microm in the right eye and 42.2 microm in the left eye. Preoperative corneal topography was normal and did not reveal forme fruste keratoconus. RESULTS: Twenty-four months postoperatively, the patient developed bilateral inferior keratectasia of +0.50 -3.00 x 72 degrees in the right eye and +1.00 -2.75 x 99 degrees in the left eye. CONCLUSIONS: Late keratectasia may follow LASIK for low myopia despite a thorough preoperative work-up.     

Contact lens fitting difficulties following refractive surgery for high myopia.

PURPOSE: To describe the clinical and optical problems encountered in contact lens fitting following refractive surgery for high myopia. METHODS: Following refractive surgery for high myopia (greater than -10.00 D) we corrected residual refractive errors with contact lenses in the four eyes of two patients. The first patient had undergone bilateral laser in situ keratomileusis (LASIK),with two subsequent LASIK retreatments in the left eye. Ten months later she was fit with rigid gas permeable (RGP) lenses in both eyes. The second patient had undergone a clear lens extraction in the right eye and radial keratotomy followed by photorefractive keratectomy(PRK) in the left eye. She was fit with toric soft lenses six years postoperatively. RESULTS: Final visual acuity obtained with contact lenses was 20/25-20/20 in all eyes. The first patient required significant minus lens power compensation. Furthermore, the RGP lens in the left eye was slightly decentered due to corneal irregularity induced by LASIK. The second patient had regular corneal surfaces and was successfully fit with daily wear toric soft lenses despite the 2.75 D of residual astigmatism in the left eye. CONCLUSIONS: Following refractive surgery for high myopia a proportion of patients will remain undercorrected. In these patients the alterations in corneal architecture that ensue make contact lens fitting more challenging. Patients with regular astigmatism may be fitted successfully with toric soft lenses. Patients with corneal irregularities should be fit with RGP lenses.     

Outcome of LASIK in fleck corneal dystrophy

PURPOSE: To report the outcome of laser in situ keratomileusis (LASIK) in a patient with Fleck corneal dystrophy. METHODS: Case report and literature review. RESULTS: A 48-year-old Taiwanese man presented in November 2005, 6 years after bilateral myopic LASIK. He complained of loss of uncorrected distance visual acuity that was worse in the left eye. The patient did not report glare, halos, or other visual aberrations. Preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25 OU, with a manifest refraction of -14 D OU. In November 2005, uncorrected visual acuity (UCVA) was 20/40 OD and 20/50 OS, and BSCVA was 20/25 in each eye with a manifest refraction of -1.00 sphere OD and -1.75 -1.25 x 115 OS. Slit-lamp examination was remarkable for several subtle, small, gray corneal opacities present throughout the corneal stroma. Confocal microscopy revealed refractile bodies within swollen keratocytes and normal surrounding stromal mileu. The clinical and confocal appearance was consistent with Fleck corneal dystrophy. CONCLUSION: In this patient with Fleck corneal dystrophy, corneal clarity and BSCVA were maintained 6 years after bilateral myopic LASIK, suggesting that LASIK does not stimulate visually significant exacerbation of Fleck corneal dystrophy.     

Clinical manifestation and pathologic finding of unilateral acute hydrops after bilateral laser in situ keratomileusis

We present a case of unilateral acute hydrops that developed in 25-year-old man 6 years after bilateral laser in situ keratomileusis (LASIK) for the correction of 2.75 diopters (D) of myopia. Preoperative corneal thickness using ultrasound pachymetry were 556 microm in the right eye and 554 microm in the left eye. Preoperative corneal topography of both eyes showed an asymmetric bow-tie pattern with inferior steepening. Forty-seven months after LASIK, the left eye developed astigmatism and enhancement excimer ablation was performed. Sixteen months after enhancement, a definite sign of keratectasia was detected in the left eye. Twenty-six months after enhancement, acute hydrops occurred in the left eye. The interface of the LASIK wound was separated and filled with aqueous humor. Penetrating keratoplasty was performed to avoid perforation. The keratocytes at the edge between the peripheral flap and remaining stroma showed mixoid degeneration and edematous change suggesting dying cells.     

Contact lens fitting in a patient with keratectasia after laser in situ keratomileusis

We present a case of unilateral iatrogenic keratectasia developing 15 months after bilateral laser in situ keratomileusis using a broad-beam excimer laser (Bausch & Lomb Keracor 116) to treat -3.5 -1.5 x 85 diopters of myopia. Preoperative pachymetry in the eye measured 450 microm without topographical changes suggesting keratoconus or forme fruste keratoconus. Contact lens fitting to provide 20/25 visual acuity is described.     

Keratectasia after bilateral laser in situ keratomileusis in a patient with previous radial and astigmatic keratotomy

We describe a case of bilateral keratectasia after laser in situ keratomileusis (LASIK) in a patient with previous radial keratotomy and astigmatic keratotomy. The best spectacle-corrected visual acuity (BSCVA) was 20/25 in both eyes. After uneventful LASIK was performed in both eyes for low myopic astigmatism, the patient presented with progressive myopia and astigmatism and a BSCVA of 20/50 in both eyes. Videokeratography showed progressive deformation of the cornea, increasing K-values over 50.0 diopters, and irregular astigmatism. The best corrected visual acuity in both eyes improved to 20/25 with rigid poly(methyl methacrylate) contact lenses.     

中低度近视SBK与LASIK术后角膜后表面高度的临床研究

目的:探讨中低度近视前弹力层下激光角膜磨镶术(sub-Bowmans keratomileusis,SBK)及准分子激光原位角膜磨镶术(laser in situkeratomi leusis,LASIK)术后角膜后表面高度的变化。方法:中低度近视患者108例216眼,前瞻性、随机性为其1眼行SBK手术,其对侧眼行LASIK手术,术前及术后1wk;1,3,6mo应用Pentacam三维眼前节分析系统检查,分析比较SBK和LASIK两组间各个不同时间点的角膜后表面高度。结果:术后所有患者视力均达到或超过术前矫正视力。经配对t检验,SBK组和LASIK组术前术后,术后各时间段的比较,差异均无统计学意义。各时期两组间角膜后表面高度值比较,差异亦无统计学差异。结论:SBK和LASIK手术对中低度近视患者术后角膜后表面高度无明显影响。     

Latrogenic keratectasia following laser in situ keratomileusis

PURPOSE: To evaluate keratectasia after laser in situ keratomileusis (LASIK) for high myopia. METHODS: A 49-year-old male patient with myopia of -23.50 D in both eyes underwent LASIK with a Summit Technology Apex Plus excimer laser. A Moria manually-guided MDSC microkeratome was used. Preoperative corneal topography in both eyes did not reveal underlying or fruste form of keratoconus. Four months after LASIK, a progressive keratectasia occurred in right eye and after 12 months, in left eye. Corneal transplantation was performed in both eyes. RESULTS: Histological and ultrastructural examinations were performed on one corneal button. The analysis showed regular stromal morphology and cellularity, with no sign of inflammation. The morphometric analysis showed an overall thickness of 334 microm, with a flap of 262 microm and a stromal residual bed of 72 microm, in the center of the button. CONCLUSION: A LASIK corneal flap made with a planned 120-microm plate turned out histologically to be approximately 260 microm thick, in an eye with a refractive correction of -23.50 D. The excessive flap thickness and excessive ablation produced progressive keratectasia requiring a penetrating keratoplasty.     

Keratectasia after LASIK but not after PRK in one patient

PURPOSE: To report a case of keratectasia in a patient who underwent LASIK in the right eye and photorefractive keratectomy (PRK) in the left eye for correction of compound myopic astigmatism. METHODS: A 30-year-old man underwent LASIK in the right eye and PRK in left eye for refraction of -1.75 -1.50 x 48 degrees and -1.00 -1.75 x 100 degrees, respectively. Preoperative corneal thickness was 447 microm in the right eye and 446 microm in the left eye. RESULTS: Postoperative corneal thickness decreased to 341 microm and 384 microm in the right and left eye, respectively. Uncorrected visual acuity in the left eye was 20/20, but the right eye developed keratectasia, which led to severe visual loss (20/400). CONCLUSIONS: Photorefractive keratectomy may be better than LASIK for ablative refractive surgery for low myopic astigmatism in eyes with low central corneal thickness.