Abstract：
OBJECTIVE: The purpose of this study was to report an isolated case of 2 siblings who developed central toxic keratopathy (CTK) after undergoing laser-assisted keratomileusis (LASIK) on the same day.
METHODS: This was a case report and literature review.
RESULTS: Two sisters with no significant medical history underwent uncomplicated LASIK on the same day. Postoperative day 1 slitlamp examination findings were unremarkable. One week later, both patients returned for routine examination and were found to have a reduction in visual acuity, hyperopic shift, bilateral central opacification at the interface, and characteristic posterior stromal \"mud cracks\" or macrostriae most consistent with the entity CTK. The patients reported only mild ocular discomfort with minimal signs of inflammation. None of the other LASIK patients from the same surgery day nor any previous or following days thereafter developed any complications. The siblings were closely followed and treated with a short course of prophylactic topical antibiotics and rapid steroid taper, along with aggressive lubrication and long-term systemic treatment including oral doxycycline, vitamin C, and coenzyme Q10. Three months later, both patients had resolution of CTK with an uncorrected visual acuity of 20/20 or better in both eyes.
CONCLUSIONS: CTK is a rare, noninflammatory but potentially sight-threatening entity most commonly associated with excimer laser ablation procedures. Its pathophysiology is poorly understood but likely multifactorial. Its isolated presentation in this case of 2 siblings suggests a possible underlying genetic predisposition, which has not been previously described. With careful monitoring and early supportive treatment, patients can have a complete and rapid resolution.
METHODS: This was a case report and literature review.
RESULTS: Two sisters with no significant medical history underwent uncomplicated LASIK on the same day. Postoperative day 1 slitlamp examination findings were unremarkable. One week later, both patients returned for routine examination and were found to have a reduction in visual acuity, hyperopic shift, bilateral central opacification at the interface, and characteristic posterior stromal \"mud cracks\" or macrostriae most consistent with the entity CTK. The patients reported only mild ocular discomfort with minimal signs of inflammation. None of the other LASIK patients from the same surgery day nor any previous or following days thereafter developed any complications. The siblings were closely followed and treated with a short course of prophylactic topical antibiotics and rapid steroid taper, along with aggressive lubrication and long-term systemic treatment including oral doxycycline, vitamin C, and coenzyme Q10. Three months later, both patients had resolution of CTK with an uncorrected visual acuity of 20/20 or better in both eyes.
CONCLUSIONS: CTK is a rare, noninflammatory but potentially sight-threatening entity most commonly associated with excimer laser ablation procedures. Its pathophysiology is poorly understood but likely multifactorial. Its isolated presentation in this case of 2 siblings suggests a possible underlying genetic predisposition, which has not been previously described. With careful monitoring and early supportive treatment, patients can have a complete and rapid resolution.
摘要：
目的：本研究的目的是报告1例2名同日行激光辅助角膜磨镶术（LASIK）后出现中枢中毒性角膜病变（CTK）的兄弟姐妹。
方法：这是一例病例报告并文献复习。
结果：两名无明显病史的姐妹在同一天接受了无并发症的LASIK手术。术后第1天狭缝灯检查结果无明显变化。一周后,两名患者返回进行常规检查，发现视力下降，远视移位,界面处的双边中央不透明，和特征性的后部基质“泥浆裂缝”或与实体CTK最一致的大条纹。患者仅报告了轻度的眼部不适，炎症症状最少。来自同一手术日的其他LASIK患者以及此后的任何先前或随后几天均未出现任何并发症。密切关注兄弟姐妹，并接受短期预防性局部抗生素和快速类固醇锥度治疗，随着积极的润滑和长期的全身治疗，包括口服多西环素，维生素C,和辅酶Q10。三个月后,两名患者的CTK分辨率均为,双眼未矫正视力为20/20或更高.
结论：CTK是一种罕见的，非炎性但潜在的视力威胁实体最常见于准分子激光消融手术。对其病理生理学了解甚少，但可能是多因素的。在2个兄弟姐妹的情况下，它的孤立表现表明可能存在潜在的遗传易感性，以前没有描述过。仔细监测和早期支持治疗，患者可以有一个完整和快速的解决。
方法：这是一例病例报告并文献复习。
结果：两名无明显病史的姐妹在同一天接受了无并发症的LASIK手术。术后第1天狭缝灯检查结果无明显变化。一周后,两名患者返回进行常规检查，发现视力下降，远视移位,界面处的双边中央不透明，和特征性的后部基质“泥浆裂缝”或与实体CTK最一致的大条纹。患者仅报告了轻度的眼部不适，炎症症状最少。来自同一手术日的其他LASIK患者以及此后的任何先前或随后几天均未出现任何并发症。密切关注兄弟姐妹，并接受短期预防性局部抗生素和快速类固醇锥度治疗，随着积极的润滑和长期的全身治疗，包括口服多西环素，维生素C,和辅酶Q10。三个月后,两名患者的CTK分辨率均为,双眼未矫正视力为20/20或更高.
结论：CTK是一种罕见的，非炎性但潜在的视力威胁实体最常见于准分子激光消融手术。对其病理生理学了解甚少，但可能是多因素的。在2个兄弟姐妹的情况下，它的孤立表现表明可能存在潜在的遗传易感性，以前没有描述过。仔细监测和早期支持治疗，患者可以有一个完整和快速的解决。
