背景:圆锥角膜是最常见的非炎性双侧角膜扩张症。春季角膜结膜炎(VKC)和擦眼可能与儿童和年轻人的圆锥角膜有关。晚期圆锥角膜的及时管理对提高视觉质量很重要。此外,为了避免点状上皮性角膜炎的发生而进行VKC治疗具有挑战性,溃疡,或角膜移植物上的角膜新生血管形成。
方法:我们报告了一例18岁男性患者,该患者长期因巨脑症而出现精神发育迟滞病史,表现为急性角膜积液,并伴有突出的膨出和难治性类固醇诱导的右眼青光眼。由于晚期扩张,右眼的地形无法获得,左眼显示中央陡峭化,下上屈光不对称性。根据临床发现,患者被诊断为圆锥角膜。由于进行性角膜混浊和新生血管形成,患者接受了穿透性角膜移植术(PK),并在右眼接受了术前结膜下注射贝伐单抗后,结合了中断和基质内缝合,其次是下眼睑矫正。手术后,患者接受0.1%他克莫司皮肤科软膏治疗,0.1%环孢素滴眼液,人工泪液,和0.5%乐泰普利用于角膜移植术和VKC。向患者提供了避免擦眼的反复教育。PK治疗两年后,他的右眼最佳矫正视力从术前10cm的手部活动成功改善至术后6/20。
结论:大直径PK结合基质内缝合技术治疗晚期圆锥角膜可获得更好的视觉效果并避免缝合相关并发症。此外,他克莫司皮肤软膏而不是他克莫司局部滴眼液或软膏与局部环孢素和类固醇联合使用时显示出令人满意的疗效,PK后未发现明显的VKC再激活。
BACKGROUND: Keratoconus is the most common noninflammatory bilateral corneal ectasia. Vernal keratoconjunctivitis (VKC) and eye rubbing may be associated with keratoconus in children and young adults. Timely management of advanced keratoconus is important to improve visual quality. In addition, it is challenging to carry out VKC treatment with an intent to avoid the occurrence of punctate epithelial keratitis, ulceration, or corneal neovascularization on corneal grafts.
METHODS: We report the
case of an 18-year-old male patient with a long-term history of mental retardation due to megalencephaly presenting with acute onset of corneal hydrops with prominent bulging and refractory steroid-induced glaucoma of the right eye. The topography of the right eye was unavailable due to advanced ectasia, and that of the left eye revealed central steepening with inferior-superior dioptric asymmetry. According to the clinical findings, the patient was diagnosed with keratoconus. Because of progressive corneal opacity and neovascularization, the patient underwent penetrating keratoplasty (PK) with combination of interrupted and intrastromal running suturing after receiving a preoperative subconjunctival injection of bevacizumab in his right eye, followed by lower eyelid correction. After surgery, the patient was treated with 0.1% tacrolimus dermatological ointment, 0.1% cyclosporine eye drops, artificial tears, and 0.5% loteprednol for keratoplasty and VKC. Repeated education on avoiding eye rubbing was offered to the patient. Two years after PK treatment, his best-corrected visual acuity of the right eye successfully improved from hand motion at 10 cm preoperatively to 6/20 postoperatively.
CONCLUSIONS: Large-diameter PK with intrastromal suturing technique for advanced keratoconus could achieve better visual outcomes and avoid suture-related complications. In addition, tacrolimus dermatological ointment rather than tacrolimus topical eye drops or ointment showed satisfactory efficacy when combined with topical cyclosporine and steroid that no significant VKC reactivation were noted after PK.