Description, Etiology, and Prevention of an Outbreak of Diffuse Lamellar Keratitis After LASIK

Abstract

PURPOSE: To describe an outbreak of diffuse lamellar keratitis (DLK) and provide a hypothesis about the etiology. METHODS: A retrospective analysis was carried out on 328 eyes of 220 patients who underwent LASIK over 9 months. The occurrence of DLK using two different methods of cleaning and sterilizing surgical instruments and an autoclave reservoir were analyzed. Microbial analyses were carried out by two laboratories on samples obtained from the original autoclave reservoir and tubing. A chi-square test was used to compare qualitative values. The Student t test was used to compare numerical values.

Diffuse lamellar keratitis after laser in situ keratomileusis associated with surgical marker pens

“…There are few reports of outbreaks of DLK, 5,13 and the specific causative factor is usually not known. It is generally agreed that DLK is caused by a contaminant in the [4][5][6][7][8][9][10][11][12][13][14][15] have been shown to be associated with DLK. To our knowledge, there are no previous reports of an association between the use of surgical marker pens and DLK.…”

“…They include meibomian gland secretions, silicates, microkeratome oil, hemoglobin, povidone-iodine solution, bacterial endotoxin, metallic fragments, cleaning solutions, toxic chemicals, and silicone oil on surgical gloves. [4][5][6][7][8][9][10][11][12][13][14][15] In this paper, we report a cluster of DLK cases that was associated with a particular brand and batch of surgical markers used during the LASIK procedure. At the Singapore National Eye Centre (SNEC), there are strict protocols for the introduction of new equipment and consumables (including new batches of consumables) for all LASIK procedures performed.…”

Biofouling of surgical power tools during routine use

“…In that study, Gram-negative organisms (Sphingomonas paucimobilis and Burkholderia pickettii) were isolated from the reservoir of the steam sterilizer used for the instruments, and it is thought that bacterial endotoxin may have survived the short-cycle steam sterilization and led to the outbreak. 79 …”

LASIK interface keratitis: epidemiology, diagnosis and care

“…During epidemics, factors found to be responsible for outbreaks include endotoxin contamination of sterilizers [30][31][32], certain types of surgical gloves [33,34], certain types of surgical marking pens [35,36], exposure of surgical instruments to toxic chemicals [37] and certain detergents used in cleaning surgical instruments [38]. If an outbreak is suspected, a methodical investigation should be performed to discover and correct the inciting factor.…”