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Corneal Perforation during the Enhancement of Laser in Situ Keratomileusis-A Case Report
雷射原位層狀角膜重塑術引發角膜穿孔－病例報告
摘要
目的：病例報告一因雷射原位層狀角膜重塑術引發角膜穿孔。 方法：一位36歲女性因高度近視接受雷射原位層狀角膜重塑術後。左眼因為殘餘度數而接受第二次手術卻時發生角膜穿孔。吾人使用細隙燈，角膜弧度測量儀，矯正視力，Orbscan角膜等高屈度儀，角膜內皮側量儀，及角膜厚度測量儀做為追蹤病情之工具。 結果：細隙燈檢查發現角膜內皮細胞有不規則表面及結疤組織，中心角膜也呈現不規則厚度及向前傾突。角膜內皮細胞測量儀可測量出周邊正常角膜內皮細胞，卻無法測得中央角膜內皮細胞。由Orbscan角膜等高屈度儀發現後角膜弧度變性(ectasia)及不規則散光，角膜厚度為399微米。角膜厚度儀則測出角膜厚度為316微米。 結論：Orbscan角膜等高屈度儀錯誤估量角膜厚度以及在第一次手術之後不明原因的角膜變性為此次病例報告角膜穿孔的主要原因。藉由各種不同儀器測量角膜弧度與厚度並相互映證，將可以減少雷射原位層狀角膜重塑術的併發症。
關鍵字
無資料並列摘要
Purpose: To report a case of corneal perforation during the retreatment of laser in situ keratomileusis (LASIK). Method: A 36-year-old female patient with excessive myopia underwent LASIK. Corneal perforation was noted during the retreatment for residual myopia. Slit-lamp biomicroscopy, keratometry, and visual acuity were used for following the clinical course, so were Orbscan topography, specular microscopy, and pachymeter. Result: Eight months after the corneal perforation, slit-lamp biomicroscopic examination revealed irregular surface and scarring of endothelium and abnormal thinning on the central zone of cornea. Specular microscope failed to detect any endothelium on optic zone in spite of normal endothelium in the periphery. Orbscan topography analysis showed corneal ectasia in the posterior surface and irregular astigmatism around the site of perforation. Corneal thickness was measured 31 6um by pachymetry examination, but 399um by Orbscan topography. Conclusion: Unexpected corneal ectasia after the first LASIK treatment may cause a corneal perforation in LASIK retreatment in this case. Careful examination of the corneal curvature and thickness by all kinds of special instrumentations is necessary to prevent corneal perforation during laser ablation in LASIK.
延伸閱讀
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