Diffuse lamellar keratitis: Diagnosis and management

Abstract

With the volume of laser in situ keratomileusis procedures growing exponentially, ophthalmologists and other eye-care providers are becoming aware of an uncommon postoperative condition, diffuse lamellar keratitis, that can affect an otherwise ideal outcome. We present our strategy for diagnosing and managing this syndrome, developed from experience in a high-volume refractive surgical practice. Understanding the time course of the disease, along with proper identification, staging, and intervention, can help eliminate visual loss associated with this condition.

LASIK interface primary complications

“…However, in most cases, especially in epidemic DLK, it has been associated to the presence of bacterial endotoxins (2,8,9) , meibomian glandular secretions and peripherals immune infiltrates, atopy, iatrogenic epithelial defects or resulting from problems during the process of sterilization of instruments, related for example to gloves and surgical marking pens. Finally, DLK is probably the result of endogenous risk factors of the patient in response to exogenous exposure (10) , though isolated cases of idiopathic DLK have also been sporadically observed (11) . However, if many cases happen in a short period of time, precautions should be taken to assess sterilization process (2,8) .…”

“…According to Linebarger, DLK is divided into four phases according to its clinical presentation (10) : Diffuse lamellar keratitis seems to be slightly more common with the use of femtosecond laser compared to the microkeratome for making the flap. Studies have shown that high levels of laser energy result in tissue injury induced by photodisruption, causing accumulation of gas bubbles which may lead to an increased inflammatory response of DLK.…”

“…Many surgeons advocate the use of oral steroids in phases 2 and 3 of DLK associated to elevation and irrigation of the flap for phase 2 and which are not responding quickly to the treatment and all cases in phase 3 (2,15,16) . For stage 4, the steroids may be used in order to minimize the scar density and can be partially effective, and elevating the flap is controversial (10,15) . Some surgeons advocate cautious raising of the flap and irrigation to remove toxins, but such action should be performed extremely carefully and measures should be taken to prevent the loss of tissue, that is why some authors defend not elevating the flap at this stage (10) .…”

“…For stage 4, the steroids may be used in order to minimize the scar density and can be partially effective, and elevating the flap is controversial (10,15) . Some surgeons advocate cautious raising of the flap and irrigation to remove toxins, but such action should be performed extremely carefully and measures should be taken to prevent the loss of tissue, that is why some authors defend not elevating the flap at this stage (10) . The uncorrected and corrected visual acuity after the treatment of DLK is usually good (2,8,11) .…”

Refractive surgery or contact lenses – how and when to decide?

“…24,88,89 Postoperative complications include dislodging of the flap, flap striae, interface debris, epithelial downgrowth, and diffuse lamellar keratitis. 24,90,91 Posterior segment complications, such as posterior vitreous detachment, [92][93][94] Clinical Optometry downloaded from https://www.dovepress.com/ by 54.191.190.102 on 13-May-2018 For personal use only.…”