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Traumatic laser in situ keratomileusis flap dislocation with epithelial ingrowth, Propionibacterium acnes infection, and diffuse lamellar keratitis
摘要： Rationale: Traumatic ?ap dislocation might occur anytime after laser in situ keratomileusis (LASIK), but it is rarely concomitantly complicated with epithelial ingrowth, infectious keratitis, and diffuse lamellar keratitis altogether. Here we report a case of traumatic LASIK ?ap inversion with epithelial ingrowth, Propionibacterium acnes infection, and diffuse lamellar keratitis. Patient concerns: A 42-year-old man receiving bilateral LASIK surgery 10 years ago complained of right eye pain for 6 days after twig injury. Temporal ?ap inversion with epithelial ingrowth and dense in?ltration at the interface were noted. Diagnoses: Traumatic LASIK ?ap inversion with epithelial ingrowth, Propionibacterium acnes infection and diffuse lamellar keratitis. Interventions: Removal of corneal epithelium around the ?ap inversion site, ?ap lifting, scraping of epithelial ingrowth, removal of the dense in?ltrate, alcohol soaking, interface irrigation with antibiotics, and ?ap reposition were performed. Diffuse lamellar keratitis was noted postoperatively. Culture of the in?ltrate revealed P acnes. The in?ltrate subsided and the cornea cleared up under topical antibiotics and steroid. Outcomes: The visual acuity returned to 20/20. No recurrent epithelial ingrowth or in?ltrate was noted during the follow-up. Lessons: This is the ?rst report of Propionibacterium acnes keratitis after traumatic ?ap inversion. Although epithelial ingrowth, infectious keratitis, and diffuse lamellar keratitis all developed after the ?ap inversion, early recognition and proper intervention lead to a good result without sequels.
关键词： Propionibacterium acnes,?ap dislocation,LASIK,infectious keratitis,diffuse lamellar keratitis,case report,epithelial ingrowth
更新于2025-09-19 17:13:59
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Primary percutaneous coronary intervention for a left main bifurcation lesion without stenting using excimer laser with optical coherence tomography guidance: a case report
摘要： Optimal strategy for treating bifurcation lesions or lesions with large thrombus in left main disease remains elusive. Excimer laser coronary angioplasty (ELCA) is a therapeutic option for thrombotic lesions in acute coronary syndrome. A 68-year-old man with chest pain was transferred to our emergency department, and subsequently diagnosed as inferior ST-segment elevation myocardial infarction (STEMI). Emergent coronary angiography revealed a 75% stenosis in the left main trunk (LMT). Optical coherence tomography (OCT) showed massive thrombus at the distal LMT to the ostial left anterior descending artery (LAD) and left circumflex artery (LCx). ELCA was performed in the three directions from LMT to proximal LAD, proximal LCx, and obtuse marginal branch. OCT after ELCA showed reduction of thrombus and no apparent plaque rupture or calcification, implying that coronary thrombosis was caused by OCT-defined plaque erosion. Intracoronary electrocardiogram of the LCx showed ST-segment elevation which corresponded to inferior ST-segment elevation, whereas no intracoronary electrocardiogram ST-segment elevation was detected for LAD. Taking all of the data including angiographic appearance, OCT-derived residual lumen size and residual thrombus volume, and strategic options into consideration, we completed percutaneous coronary intervention without stent deployment. He has been free from any cardiac events thereafter for 8 months. Optimal strategy of coronary intervention for bifurcation lesions, especially LMT bifurcations, remains elusive. ELCA may have a potential to safely reduce intracoronary thrombus in patients presenting with acute coronary syndrome with OCT guidance.
关键词： Plaque erosion,Excimer laser coronary angioplasty,Case report,Bifurcation,Left main disease,Stentless
更新于2025-09-19 17:13:59
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Diode laser transscleral cyclophotocoagulation for uveitis-glaucoma-hyphema syndrome
摘要： Rationale: To report a case of diode laser transscleral cyclophotocoagulation (DLTSC) for uveitis-glaucoma-hyphema syndrome (UGH). Patient concerns: The patient developed UGH on the right eye (OD) after vitrectomy and intraocular lens (IOL) implantation. Diagnoses: Best corrected visual acuity (BCVA) was HM/50 cm, intraocular pressure (IOP) was 51.3 mm Hg on the OD. He was found to have 3+ anterior chamber cells. A B-scan ultrasound showed vitreous opacity. Ultrasound biomicroscopy (UBM) showed the chafing between the IOL and the posterior surface of the iris. Thus, he was diagnosed as UGH on the OD. Interventions: The patient was worried about the complications for removal of the IOL, a DLTSC approach was performed. Outcomes: BCVA was 20/40 on the OD, IOP was 12 mm Hg on the OD. There were no anterior chamber inflammation and no vitreous opacity. UBM showed there was no contact between IOL and the posterior surface of the iris, the fundus of the eye was clearly visible. Lessons: UGH syndrome is a severe complication of cataract extraction. IOL extraction has been the traditional approach to treatment. DLTSC can be an option when the IOL is slightly tilted.
关键词： acrylic single-piece intraocular lens,uveitis-glaucoma-hyphema (UGH) syndrome,diode laser transscleral cyclophotocoagulation,case report
更新于2025-09-19 17:13:59
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Foveal choroidal neovascularization secondary to accidental laser exposure in a dermatologist
摘要： Rationale: Most laser-induced retinal injuries are caused by accidental laser discharge during the preparation of laser devices without protective goggles, laser injury during the cosmetic procedure in a dermatologist, is very rare, with no prior case reports. Patient concerns: A 55-year-old Asian male dermatologist visited our hospital with a 2-week history of visual disturbance in his right eye. He had experienced sudden central scotoma in the right eye while using a Q-switched Nd:YAG laser (1064 nm, 2 J/cm2, 6-mm spot size, 750 ps) 2 to 3 cm from the target without proper eye protection. He had applied a glass slide ?rmly onto the treatment area prior to commencing the procedure. The choroidal neovascularization (CNV) was detected via optical coherence tomography angiography (OCTA) 2 weeks after the laser injury. Diagnosis: Foveal CNV secondary to laser energy re?ected from the glass slide. Intervention: Intravitreal bevacizumab (1.25 mg/0.05 mL) injection was performed. Outcomes: Regression of CNV was observed. Lessons: Retinal injury can occur not only by direct laser beam exposure but also by way of a beam re?ected from a glass slide. Operators should always use laser safety eyewear during cosmetic procedures involving laser devices, so as to prevent the occurrence of ocular complications. Thorough short-term follow-up with OCTA is recommended for the prompt detection of CNV in cases of retinal laser injury.
关键词： fovea,case report,retina,laser,choroidal neovascularization
更新于2025-09-12 10:27:22