背景:据报道,准分子激光原位角膜磨镶术(LASIK)后出现短暂性干眼症状。很少,患者可能出现干眼综合征(DES)的衰弱症状,眼表疾病的证据有限或没有.这些患者被诊断患有称为神经性角膜疼痛(NCP)的DES形式。
方法:本研究是对一系列病例的回顾性医疗记录回顾,这些病例包括在1996-2021年期间在LASIK术后发展为NCP的18例患者。纳入所有符合NCP的LASIK术后出现严重眼部疼痛的患者。不包括患有严重眼表疾病或其他眼科病因以解释其衰弱症状的严重眼部疼痛患者。
结果:我们研究的患者平均年龄为39.5岁。我们的大多数患者是女性(72.2%)和高加索血统(83.3%)。LASIK术后症状的平均发作时间为9.6个月。患者过去有明显的神经精神疾病病史(50%),功能性疼痛综合征(22.2%),自身免疫性疾病(33.3%),和甲状腺功能减退(27.8%),这些疾病的发病率高于这些疾病的全国患病率。症状与定义NCP的严重程度和特征一致。治疗是多模式的,涉及局部和全身治疗,对每个病人来说都是独一无二的.总的来说,大多数患者在接受定期随访治疗后,临床症状得到改善.
结论:虽然罕见,在我们的研究中,NCP在LASIK术后26年的患病率约为900例中的1例.手术后的平均发病时间延迟为9.6个月。某些危险因素,如神经精神疾病,功能性疼痛综合征的病史,自身免疫性疾病史,甲状腺功能减退可能会使患者容易患上这种疾病。患者受益于正确的诊断和多模式治疗方法。
BACKGROUND: Transient dry eye symptoms have been reported following laser in situ keratomileusis (
LASIK). Very rarely, patients may present with debilitating symptoms of dry eye syndrome (DES) with limited or no evidence of ocular surface disease. These patients are diagnosed with a form of DES known as neuropathic corneal pain (NCP).
METHODS: This study is a retrospective medical record review of a
case series of 18 patients who developed NCP post-
LASIK over the years 1996-2021. All patients who developed severe ocular pain following
LASIK consistent with NCP were included. Patients with severe ocular pain who had evidence of severe ocular surface disease or other ophthalmic etiology to explain their debilitating symptoms were not included.
RESULTS: The average age of patients in our study was 39.5 years. The majority of our patients were female (72.2%) and of Caucasian ancestry (83.3%). The average onset of symptoms was 9.6 months post-
LASIK. Patients had past medical histories significant for neuropsychiatric conditions (50%), functional pain syndromes (22.2%), autoimmune diseases (33.3%), and hypothyroidism (27.8%), and the occurrence of these was higher than the national prevalence of these diseases. Symptoms were consistent with the severity and characteristics defining NCP. Treatment was multimodal, involved topical and systemic therapies, and was unique to each patient. Overall, the majority of patients had clinical improvement in symptoms following treatment with regular follow-up.
CONCLUSIONS: Although rare, the 26-year prevalence of NCP post-LASIK in our study was roughly 1 in 900 cases. The mean time to onset after surgery was delayed at 9.6 months. Certain risk factors such as neuropsychiatric conditions, history of functional pain syndromes, history of autoimmune conditions, and hypothyroidism may predispose patients to the development of this condition. Patients benefited from proper diagnosis and a multimodal approach to treatment.