[Analysis of clinical characteristics and risk factors of corneal melting after laser in situ keratomileusis].
OBJECTIVE
To study the characteristics of corneal melting after laser in situ keratomileusis and to investigate the risk factors for corneal melting.


METHODS
Twelve eyes of 11 patients with corneal melting after LASIK were studied. The patients consisted of 6 men and 5 women, ranging in age from 26 to 41 years. Each eye was routinely examined with slit lamp microscope and confocal microscope. All patients were conducted with systemic examination, especially immunologic index such as rheumatoid factor, anti-SSA and anti-SSB antibodies. The patients with systemic diseases were treated for the systemic diseases as well as for the ocular disorders.


RESULTS
Corneal melting occurred unilaterally in all cases; 8 in the left eye and 4 in the right eye. The intervals between onset of corneal melting and LASIK ranged from 2 to 5 weeks. Corneal melting tended to begin from the rim of corneal flaps, especially in the inferior and nasal rims. Eight cases (67%) either had corneal epithelium denudation or thinner corneal flaps during operation or had corneal epithelium edema or epithelium implantation post operatively. 6 cases (55%) were combined with systemic diseases, 1 with thyroiditis, 2 with systemic lupus erythematous, 2 with Sjogren syndrome and 1 with rheumatoid arthritis. One patient once had superficial scleritis, one patient was combined with eczema and erythema of the skin; one patient had foreign body beneath the corneal flap; other patients had no accompanying disorders (3 eyes). All of the cases were cured with treatment by cyclosporine A, topical steroids and protective agents for the cornea. The course of corneal melting ranged from 23 days to 45 days (mean 30.3 days). Corneal nebula or macula of different degrees remained. Four cases had astigmatism with sphere changes above 1.0 diopters. The actual corrected visual acuity of 5 eyes was 2 lines lower than the expected corrected visual acuity, 2 eyes 1 line lower, 5 eyes unchanged.


CONCLUSIONS
Corneal melting is a non-infectious corneal disorder and may accompany with systemic diseases. LASIK may be an inductive factor for corneal melting. A thorough inquiry and examination for systemic diseases are of great importance for the prevention of corneal melting. The treatment for corneal melting should be combined with diagnosis and treatment for the accompanying systemic diseases.
Li
Ying
Y
Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China. liyingpumch@sohu.com
Li
Hai-Yan
HY
D000328:Adult; D001327:Autoimmune Diseases / Q000209:etiology / Q000517:prevention & control; D003316:Corneal Diseases / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D012307:Risk Factors