Late-Onset Traumatic Flap Dislocation and Diffuse Lamellar Keratitis after Laser in Situ Keratomileusis: A Case Report

雷射屈光手術術後之遲發性創傷性角膜瓣移位合併廣泛性層狀角膜炎－病例報告

廖建銘(Chien-Ming Liao) ； 林祐詩(Jack Yu-Shih Lin) ； 游高魁(Kao-Kwei Yu) ； 鄭玠峰(Chieh-Feng Cheng) ； 蔡正隆(Chen-Long Tsai) ； 宋穗佳(Sui-Chia Sung) ； 吳建良(Chien-Liang Wu)

《中華民國眼科醫學會雜誌》 46卷4期 (2007/12) Pp. 456-461

https://doi.org/10.30048/ACTASOS.200712.0011

摘要

目的：報告一例雷射屈光手術術後，十二個月後之創傷性角膜瓣移位合併廣泛性層狀角膜炎。
方法：病例報告。
結果：此皺折性角膜瓣移位，主要位在鼻側下方位置。處置方式：將角膜瓣復位合併部分上皮切除、並使用平衡性鹽溶液加以沖洗、並覆蓋上一治療性隱形眼鏡。在創傷後三天發現廣泛性層狀角膜炎；並在創傷後第三天，當上皮細胞缺損完全復原後，給予眼用類固醇加以成功治療。創傷後第六天，病人視力獲得改善並達到20/20。
結論：應該給予雷射屈光手術病人術後衛教，告知病患若要從事接觸性運動，有可能會造成創傷性角膜瓣移位，且應該建議此類病患若從事相關活動，應該配戴護目鏡。

並列摘要

Purpose: To report a case of partial flap dislocation and subsequent diffuse lamellar keratitis (DLK) 12 months after laser in situ keratomileusis (LASIK).
Methods: A case report of a late flap dislocation that occurred during routine recreational activity (the left eye was struck by a teammate’s elbow while playing basketball).
Results: Partial dislocation of the LASIK flap was located at the inferonasal site with wrinkles. The flap was repositioned with a partial epithelial keratectomy and balance salt saline irrigation of the interface. After flap repositioning, a bandage contact lens was put in place. DLK, which developed 3 days after the trauma, was successfully treated with frequent application of topical steroids, which was begun from day 2 after the epithelial defect had healed. Six days after the injury, the patient had recovered 20/20 uncorrected visual acuity.
Conclusions: Patients should be appropriately warned of the possibility of late flap dislocation with traumatic forces encountered during contact sports. Patients should be advised to wear goggles when participating in such recreational activities.

並列關鍵字

LASIK ； flap ； late-onset ； dislocation