Sutura corneana em hidrópsia aguda secundária à ectasia pós LASIK: relato de caso

A ectasia corneana é uma das principais complicações das cirurgias refrativas. Neste caso, descrevemos um caso de ectasia corneana induzida por laser-assisted in situ keratomileusis, que evoluiu com hidrópsia aguda e extravasamento de humor aquoso, necessitando de sutura corneana.

Descritores:
Dilatação patológica; Ectasia; Ceratomileuse assistida por excimer laser in situ, Perfuração da córnea; Hidropsia; Ceratocone

Autoria

Daniel Diniz

Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.Universidade Federal de São PauloBrazilSão Paulo, SP, BrazilDepartment of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

https://orcid.org/0000-0003-0499-4332

Fábio Mendonça Xavier Andrade

https://orcid.org/0000-0002-5184-3388

Wallace Chamon

Norma Allemann

https://orcid.org/0000-0001-5432-4287

Corresponding author: Daniel Diniz. E-mail: danieldiniz@outlook.com

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

SCIMAGO INSTITUTIONS RANKINGS

Figuras

Figuras (3)

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Figure 1
Biomicroscopy of the OS. (A, B) Initial presentation. (A) Central and near-central corneal opacity (stroma edema) with more translucent areas (intrastromal cleft) and hydrops restricted to the LASIK flap. (B) Fluorescein stain, revealing a positive Seidel on the nasal side of the LASIK flap. (C) Intraoperative image after injecting intracameral C₃F₈ gas and three sutures on the edge of the LASIK flap, decreasing stromal edema. (D) Ocular pain with angle-closure glaucoma secondary to displacement of gas to the posterior chamber on postoperative day 3, intraocular pressure 55 mmHg, and incomplete mydriasis. Note the decreased central corneal thickness on slit lamp examination. Surgical reintervention was indicated for gas aspiration. (E) Final presentation, 7 days after reintervention, with re-established corneal transparency. Note the sutures on the stromal edge of the LASIK flap and the three iridotomy laser shots at 2, 6, and 12 h. LASIK, laser-assisted in situ keratomileusis.

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Figure 2
OCT of the OS. (A, B) Initial presentation. Central and near-central corneal hyperreflectivity and thickness consistent with hydrops. (A) Vertical section. Separation of the LASIK flap from the inferior stromal bed (detachment). Central corneal thickness=612 μm. (B) Oblique section. Tear in Descemet’s membrane located inferonasally and associated with intrastromal fluid buildup (fluid-filled cleft). (C) 30-day posthydrop procedure. Vertical section. Reduced central corneal thickness, identified as 262 μm with re-established homogenous reflectivity of corneal stroma. An anterior stromal interface, consistent with a refractive surgery flap, was observed. (D) 1-year posthydrop procedure. Good coaptation of corneal lamellae and surgical incision; corneal thickness=304 μm. OCT, optical coherence tomography; OS, oculus sinister; LASIK, laser-assisted in situ keratomileusis.

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Figure 3
(A) OD. Oblique asymmetrical astigmatism, accentuated inferior near-central toricity. K_max=55.2 D associated with reduced corneal thickness and central pachymetry=446 μm (422 μm at the thinnest point). Post-LASIK ectasia. (B) OS. 30-day posthydrops. Asymmetrical and irregular astigmatism and accentuated inferior near-central toricity. K_max=68.6 D associated with reduced corneal thickness and central pachymetry=300 μm (247 μm at the thinnest point). (C) Keratometric maps prior to LASIK with corneal topography (Eyesys). OD. Accentuated corneal toricity and suspected case of ectasia. K_max=44.99 D. OS. Asymmetrical astigmatism, accentuated corneal toricity, and suspected case of ectasia. K_max=49.42 D. (D) OS. 1-year posthydrops. Greater area of asymmetrical and irregular astigmatism and accentuated inferior near-central toxicity. K_max=76.6 D associated with reduced corneal thickness and central pachymetry=347 μm (278 μm at the thinnest point). OD, oculus dextrus; OS, oculus sinister; LASIK, laser-assisted in situ keratomileusis.

Figure 1 Biomicroscopy of the OS. (A, B) Initial presentation. (A) Central and near-central corneal opacity (stroma edema) with more translucent areas (intrastromal cleft) and hydrops restricted to the LASIK flap. (B) Fluorescein stain, revealing a positive Seidel on the nasal side of the LASIK flap. (C) Intraoperative image after injecting intracameral C₃F₈ gas and three sutures on the edge of the LASIK flap, decreasing stromal edema. (D) Ocular pain with angle-closure glaucoma secondary to displacement of gas to the posterior chamber on postoperative day 3, intraocular pressure 55 mmHg, and incomplete mydriasis. Note the decreased central corneal thickness on slit lamp examination. Surgical reintervention was indicated for gas aspiration. (E) Final presentation, 7 days after reintervention, with re-established corneal transparency. Note the sutures on the stromal edge of the LASIK flap and the three iridotomy laser shots at 2, 6, and 12 h. LASIK, laser-assisted in situ keratomileusis.

Figure 2 OCT of the OS. (A, B) Initial presentation. Central and near-central corneal hyperreflectivity and thickness consistent with hydrops. (A) Vertical section. Separation of the LASIK flap from the inferior stromal bed (detachment). Central corneal thickness=612 μm. (B) Oblique section. Tear in Descemet’s membrane located inferonasally and associated with intrastromal fluid buildup (fluid-filled cleft). (C) 30-day posthydrop procedure. Vertical section. Reduced central corneal thickness, identified as 262 μm with re-established homogenous reflectivity of corneal stroma. An anterior stromal interface, consistent with a refractive surgery flap, was observed. (D) 1-year posthydrop procedure. Good coaptation of corneal lamellae and surgical incision; corneal thickness=304 μm. OCT, optical coherence tomography; OS, oculus sinister; LASIK, laser-assisted in situ keratomileusis.

Figure 3 (A) OD. Oblique asymmetrical astigmatism, accentuated inferior near-central toricity. K_max=55.2 D associated with reduced corneal thickness and central pachymetry=446 μm (422 μm at the thinnest point). Post-LASIK ectasia. (B) OS. 30-day posthydrops. Asymmetrical and irregular astigmatism and accentuated inferior near-central toricity. K_max=68.6 D associated with reduced corneal thickness and central pachymetry=300 μm (247 μm at the thinnest point). (C) Keratometric maps prior to LASIK with corneal topography (Eyesys). OD. Accentuated corneal toricity and suspected case of ectasia. K_max=44.99 D. OS. Asymmetrical astigmatism, accentuated corneal toricity, and suspected case of ectasia. K_max=49.42 D. (D) OS. 1-year posthydrops. Greater area of asymmetrical and irregular astigmatism and accentuated inferior near-central toxicity. K_max=76.6 D associated with reduced corneal thickness and central pachymetry=347 μm (278 μm at the thinnest point). OD, oculus dextrus; OS, oculus sinister; LASIK, laser-assisted in situ keratomileusis.

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Sutura corneana em hidrópsia aguda secundária à ectasia pós LASIK: relato de caso

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[1] Corresponding author: Daniel Diniz. E-mail: danieldiniz@outlook.com