Pterygium after hyperopic laser-assisted sub-epithelial keratomileusis (LASEK)

摘要

A 61-year-old Caucasian woman with hyperopia presented for laser refractive surgery. She had healthy eyes with the exception of a less than 0.5mm Salzmann's nodule at 5 o'clock near the limbus of the right eye. She underwent bilateral hyperopic laser-assisted sub-epithelial keratomileusis (LASEK) combined with removal of the Salzmann's nodule. At six months, she was emmetropic with unaided vision of 6/6; however, at 10months, she noticed a reduction of acuity in her right eye and was found to have a pterygium at 5 o'clock, encroaching 3.5mm onto the corneal surface. She underwent excision biopsy, local application of mitomycin-C (0.2mg/ml for two minutes) and conjunctival auto-grafting. Following surgery for the pterygium, vision returned to 6/6 unaided but six months later, there was limited recurrence (1.5mm) of the pterygium reducing unaided vision to 6/9, due to the induction of astigmatism of -1.25 dioptres. This has remained stable for 14months. Pterygium growth may be associated with surface excimer laser surgery and the presence of peripheral Salzmann's nodules might be a risk factor.