Abstract：
A 15-year-old boy was referred for corneal opacity evaluation. The patient had a previous herpes zoster virus (HZV) infection-varicella-zoster virus (VZV)-with ocular manifestation 1 year ago. After the infection, he developed a central corneal scar and decreased corrected distance visual acuity (CDVA) in the right eye. The slitlamp examination showed the right eye with central corneal opacity (involving anterior stroma), lacuna area between the haze, fluorescein negative, and no vascularization near the scar (Figure 1JOURNAL/jcrs/04.03/02158034-202406000-00019/figure1/v/2024-07-10T174224Z/r/image-tiff). The patient had been treated with oral valacyclovir and topical corticosteroids without any improvement of visual acuity or changes in opacity within the 1-year follow-up. His CDVA was 20/200 (-4.50 -0.75 × 25) in the right eye and counting fingers (-4.00) in the left eye. Intraocular pressure was 12 mm Hg in both eyes. Fundoscopy was normal in the right eye, but he had a macular scar in the left eye (diagnosed when he was 7 years). The left eye had no cornea signs. The patient has no comorbidity or previous surgeries. Considering this case, a corneal central scar in a 15-year-old boy, legally single eye only, and assuming it is an opacity in the anterior stroma, would you consider surgery for this patient? If so, which would you choose: Would you consider an excimer laser treatment of his ametropia while partially removing his opacity, a phototherapeutic keratectomy (PTK), or a PTK followed by a topography-guided treatment, femtosecond laser-assisted anterior lamellar keratoplasty (FALK), or deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (depending on the scar depth)? Would you consider prophylactic acyclovir during and after surgery? Would you consider any other surgical step to prevent delayed corneal healing-persistent epithelial defect? Before the surgical approach, would you consider treating this patient with topical losartan (a transforming growth factor [TGF]-β signaling inhibitor)? Would you first perform the surgery (which one) and then start the medication? Furthermore, if so, how long would you treat this patient? Would you consider treatment with another medication?
摘要：
一名15岁男孩被转诊进行角膜混浊评估。患者1年前曾患有带状疱疹病毒（HZV）感染-水痘-带状疱疹病毒（VZV）-眼部表现。感染后,他出现了中央角膜瘢痕，右眼的矫正视力（CDVA）下降。裂隙灯检查显示右眼中央角膜混浊（累及前基质），阴霾之间的缝隙区域，荧光素阴性,瘢痕附近无血管形成(图1JOURNAL/jcrs/04.03/02158034-202406000-00019/图1/v/2024-07-10T174224Z/r/image-tiff)。患者接受了口服伐昔洛韦和外用皮质类固醇治疗，在1年的随访中视力没有任何改善或混浊改变。右眼CDVA为20/200（-4.50-0.75×25），左眼数指（-4.00）。双眼眼压为12mmHg。右眼眼底镜检查正常,但是他的左眼有黄斑疤痕（在他7岁时被诊断出）。左眼没有角膜迹象。患者没有合并症或先前的手术。考虑到这个案子,一个15岁男孩的角膜中央疤痕，法律上只有一只眼睛，假设它是前基质的不透明，你会考虑给这个病人做手术吗?你会选择:你会考虑用准分子激光治疗他的屈光不正，同时部分消除他的不透明，光疗角膜切除术（PTK），或PTK，然后进行地形引导治疗，飞秒激光辅助前板层角膜移植术（FALK），或深板层角膜移植术（DALK）或穿透性角膜移植术（取决于疤痕深度）？您是否会在手术期间和手术后考虑预防性阿昔洛韦？您是否会考虑任何其他手术步骤来防止延迟的角膜愈合-持续性上皮缺损？在手术方法之前，你会考虑用局部氯沙坦(一种转化生长因子[TGF]-β信号抑制剂)治疗这个病人吗？你会先进行手术(哪一种)然后开始用药吗？此外，如果是,你会治疗这个病人多久？你会考虑用另一种药物治疗吗？
