Risk factors and prognosis for corneal ectasia after LASIK
Risk factors and prognosis for corneal ectasia after LASIK
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DOI：
10.1016/s0161-6420(02)01727-x
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发表时间：
2003-02-01
期刊：
影响因子：
13.7
通讯作者：
Stulting, RD
中科院分区：
文献类型：
--
作者：
Randleman, JB;Russell, B;Stulting, RD
目的：回顾LASIK术后角膜扩张的病例，探讨术前的危险因素，评价这些病例视力康复的方法和成功率。设计：回顾性非随机对照试验。参与者：7例LASIK术后确诊为角膜扩张的患者10只眼，33例既往报道过的角膜扩张，以及2例手术过程正常的LASIK对照组：连续100例（第一对照组），术前连续100例高度近视（bbb80屈光度[D]）（第二对照组）。方法：回顾性分析每例患者术前、术后资料，并与既往报道病例及术后病程平稳病例进行比较。主要观察指标：术前屈光、地形特征、剩余间质层厚度（RSB）、扩张发展时间、增强次数、最终最佳矫正视力（BCVA）、最终矫正方法。结果：术后随访时间平均为23.4个月（范围6 ~ 48个月）。术后发生扩张的平均时间为16.3个月（范围1 ~ 45个月）。术前屈光平均为-8.69 D，对照组为-5.37 D （P = 0.005）。术前，88%的扩张病例符合结痂性圆锥角膜的标准，而第一个对照组为2% (P < 0.0000001)，第二个对照组为4% （P = 0.0000001）。7只眼睛（70%）的RSB < 250 mum，第一对照组的16%和第二对照组的46%。扩张组的平均RSB （222.8 mum）显著低于第一对照组（293.6 mum, P = 0.0004）和第二对照组（256.5 mum, P = 0.04）。7只眼（70%）有增强。只有10%的眼睛失去了一条以上的BCVA线，所有患者最终都达到了20/30或更好的矫正视力。1例需要穿透性角膜移植术（10%），而所有其他病例都需要刚性透气性隐形眼镜进行矫正。结论：高度近视、结痂性圆锥角膜形成、低RSB是LASIK术后发生扩张的重要危险因素。除高度近视外，所有患者至少有一个危险因素，即使在控制近视的情况下，仍存在显著差异。多重增强在受影响的病例中很常见，但其致病作用尚不清楚。我们没有发现任何没有可识别的术前危险因素的扩张患者。(C) 2003年由美国眼科学会出版。
Purpose: To review cases of corneal ectasia after laser in situ keratomileusis (LASIK), identify preoperative risk factors, and evaluate methods and success rates of visual rehabilitation for these cases.Design: Retrospective nonrandomized comparative trial.Participants: Ten eyes from seven patients identified as developing corneal ectasia after LASIK, 33 previously reported ectasia cases, and two control groups with uneventful LASIK and normal postoperative courses: 100 consecutive cases (first control group), and 100 consecutive cases with high myopia (> 8 diopters [D]) preoperatively (second control group).Methods: Retrospective review of preoperative and postoperative data for each case compared with that of previously reported cases and cases with uneventful postoperative courses.Main Outcome Measures: Preoperative refraction, topographic features, residual stromal bed thickness (RSB), time to the development of ectasia, number of enhancements, final best-corrected visual acuity (BCVA), and method of final correction.Results: Length of follow-up averaged 23.4 months (range, 6-48 months) after LASIK Mean time to the development of ectasia averaged 16.3 months (range, 1-45 months). Preoperative refraction averaged -8.69 D compared with -5.37 D for the first control group (P = 0.005). Preoperatively, 88% of ectasia cases met criteria for forme fruste keratoconus, compared with 2% of the first control group (P < 0.0000001) and 4% of the second control group (P = 0.0000001). Seven eyes (70%) had RSB < 250 mum, as did 16% of eyes in the first control group and 46% of the second control group. The mean RSB for ectasia cases (222.8 mum) was significantly less than that for the first control group (293.6 mum, P = 0.0004) and the second control group (256.5 mum; P = 0.04). Seven eyes (70%) had enhancements. Only 10% of eyes lost more than one line of BCVA, and all patients eventually achieved corrected vision of 20/30 or better. One case required penetrating keratoplasty (10%), while all others required rigid gas-permeable contact lenses for correction.Conclusions: Significant risk factors for the development of ectasia after LASIK include high myopia, forme fruste keratoconus, and low RSB. All patients had at least one risk factor other than high myopia, and significant differences remained even when controlling for myopia. Multiple enhancements were common among affected cases, but their causative role remains unknown. We did not identify any patients who developed ectasia without recognizable preoperative risk factors. (C) 2003 by the American Academy of Ophthalmology.