一名被误诊为透明边缘角膜变性的患者出现进行性圆锥角膜下缘
Progressive inferior keratoconus in a patient misdiagnosed as pellucid marginal corneal degeneration.
摘要(中文译文)
一名40岁出头的患者因双眼逐渐无痛性视力下降就诊。最佳矫正视力（BCVA）右眼为20/40p，左眼为20/20。使用Pentacam（OCULUS）进行断层扫描显示，双眼角膜曲率图呈爪样外观，伴下方周边变薄，提示透明边缘性角膜变性（PMCD）。鉴于患者年龄更符合PMCD的典型表现，且存在蟹钳样形态，遂诊断为PMCD。2年内视力及断层扫描结果保持稳定。至第3年，右眼出现Vogt条纹及Fleischer环，断层扫描显示下方陡峭度增加，且下方两叶之间特征性的垂直“平坦”带消失；最佳矫正视力右眼为20/50，左眼为20/20p。诊断修正为右眼下方圆锥角膜（KC），并行去上皮胶原交联（CXL）治疗。进展性下方圆锥角膜可于50岁年龄段发病，而该年龄段早期下方圆锥角膜病例因蟹钳样外观易被误诊为PMCD。
Abstract
A patient in their early 40s presented with a bilateral gradual painless decrease in vision. Best-corrected visual acuity (BCVA) was 20/40p OD and 20/20 OS. Tomography using Pentacam (OCULUS) demonstrated a bilateral claw-like appearance on keratometry maps with inferior peripheral thinning, suggestive of pellucid marginal corneal degeneration (PMCD). Given the patient's age is more typical for PMCD and the crab-claw pattern, a diagnosis of PMCD was made. Vision and tomography were stable over 2 years. At year 3, OD developed Vogt's striae and Fleischer's ring with tomography showing increased inferior steepening and loss of the characteristic vertical 'flat' band between inferior lobes; BCVA was 20/50 OD and 20/20p in OS. The diagnosis was revised to inferior keratoconus (KC) OD and epithelium-off collagen cross-linking (CXL). Progressive inferior KC can present in the fifth decade of life, and a case of early inferior KC at this age is likely to get misdiagnosed as PMCD due to the crab-claw appearance.
如何引用
AMA
Rohini Sonar, Rashmi Deshmukh. Progressive inferior keratoconus in a patient misdiagnosed as pellucid marginal corneal degeneration.. BMJ case reports. 2026; doi:10.1136/bcr-2025-269951.
APA
Rohini Sonar, Rashmi Deshmukh (2026). Progressive inferior keratoconus in a patient misdiagnosed as pellucid marginal corneal degeneration.. BMJ case reports. https://doi.org/10.1136/bcr-2025-269951
GB/T 7714
Rohini Sonar, Rashmi Deshmukh. Progressive inferior keratoconus in a patient misdiagnosed as pellucid marginal corneal degeneration.[J]. BMJ case reports, 2026 doi:10.1136/bcr-2025-269951.
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