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AIM: To investigate the potential causes and management of the clusters of diffuse lamellar keratitis (DLK) after laser corneal refractive surgery.METHODS: The study enrolled 98 eyes (53 patients) complicated with DLK after receiving laser in situ keratomileusis (LASIK), FS-LASIK or small-incision lenticule extraction (SMILE) in our center from February 10th,2016 to February 22th,2016.They were given clinical classification treatments according to corneal layer inflammatory extent and then followed up after 1, 3, 5, 7, 10d and 1mo.RESULTS: The clusters of DLK occurred 5 times in the study period.The incidence and degree of DLK significantly decreased after changed the sterilization, surgical equipments, temperature and humidity of the operating room.There were 80 eyes (82%) had stage 1 DLK, 11 eyes (11%) had stage 2, 4 eyes (4%) had stage 3 and 3 eyes (3%) had stage 4.The incidence of DLK after FS-LASIK was 40% (79 eyes in 42 patients), that after LASIK assistant by Hastome keratome was 45% (10 eyes in 5 patients), that after SMILE was 20% (9 eyes in 6 patients).After intensive treatment, as glucocorticoid treatment and flap lifting flushing, all cases recovered within 1mo.CONCLUSION: The outbreak of DLK may be associated with the disposable item, flushing liquor, temperature and humidity of the operating room.Early diagnosis, prevention and treatment are the key of decreasing the incidence of DLK.
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PURPOSE: In the present study, a case of diffuse lamellar keratitis after trabeculectomy in a patient who had received laser in situ keratomileusis many years prior is reported. CASE SUMMARY: A 54-year-old male diagnosed with binocular primary open-angle glaucoma underwent trabeculectomy in the left eye because of poor intraocular pressure control and visual field defect progression even with maximal medical treatments. Faint, non-progressing subepithelial opacities pre-existed in the left cornea but no treatment was administered. The patient had a history of laser in situ keratomileusis in both eyes 12 years prior. On the first postoperative day, conjunctival buttonhole was found and because leaking from the hole continued, topical steroid was discontinued on the fourth postoperative day. On the seventh postoperative day, diffuse lamellar keratitis developed on the central cornea without intraocular pressure elevation, and diffuse infiltration under the corneal flap was observed in the anterior segment on optical coherence tomography. The patient was treated with topical steroid eye drops every 3 hours for the first 2 days and the frequency was increased to every hour because the keratitis did not improve. On the ninth postoperative day, keratitis began to improve and 2 months postoperatively, subepithelial lamellar infiltration improved significantly but did not show complete remission. CONCLUSIONS: Diffuse lamellar keratitis can develop in an eye with laser in situ keratomileusis after trabeculectomy if appropriate treatment with topical steroid eye drops is not administered.
Subject(s)
Humans , Male , Middle Aged , Cornea , Glaucoma, Open-Angle , Intraocular Pressure , Keratitis , Keratomileusis, Laser In Situ , Ophthalmic Solutions , Telescopes , Tomography, Optical Coherence , Trabeculectomy , Visual FieldsABSTRACT
AlM: To observe the influence on the incidence of diffuse lamellar keratitis ( DLK ) after laser in situ keratomileusis ( LASlK ) whether or not wearing sterile gloves with talc during operation, and to confirm the role of residual talc in the occurrence of DLK. METHODS: Totally 563 patients ( 1 126 eyes ) accepted operation with the method of surgical hand antisepsis only were set as the experimental group, while 592 patients ( 1 184 eyes ) with the method of surgical hand antisepsis and sterile gloves as the control group. Each patient was rechecked to observe the occurrence of DLK on the first day and the seventh day after the operation. Then the data of DLK were statistically analyzed byχ2 test and rank sum test. RESULTS:On the first postoperative day, the incidence of DLK was 7. 4% (83 eyes) in experimental group and 12. 2% (144 eyes) in control group. ln the former group, stage Ⅰ of DLK accounted for 4. 6% (52 eyes) and stageⅡ for 2. 8% (31 eyes);while in the latter, stage l did for 7. 7% (91 eyes) and stageⅡfor 4. 5% (53 eyes). On the seventh day, all DLK were cured. The other 2 cases ( 3 eyes) occurred in stage Ⅳ DLK ( the first time recheck was on the eighth day after operation and fluorometholone ophthalmic solution was not used on time ) . The incidence and the severity were both significant lower in the experimental group than in the control (both P CONCLUSlON: Talc is one of the most important factors resulting in DLK after LASlK. The method of surgical hand antisepsis without wearing gloves could avoid the stimulation of talc and reduce the incidence of DLK obviously.
ABSTRACT
La queratitis lamelar difusa es una inflamación estéril de la interfase lamelar que suele presentarse 24 horas después de la realización de la queratomileusis in situ asistida con láser y potencialmente puede comprometer la agudeza visual final. Se presenta un paciente de 25 años de edad con antecedentes de cirugía refractiva corneal mediante queratomileusis in situ con láser en el ojo derecho, que tuvo como complicación durante el acto quirúrgico un corte incompleto. En el posoperatorio inmediato se le diagnosticó una queratitis lamelar difusa. Se aplicó tratamiento local y se obtuvo la recuperación visual total del paciente con estabilidad del defecto refractivo. Esto permite posteriormente realizarle la corrección mediante cirugía refractiva de superficie
The diffuse lamellar keratitis is a sterile swelling of the lamellar interface which arises generally 24 hours after laser in situ keratomileusis and might affect the final visual acuity. A 25 years- old patient with history of corneal refractive surgery by laser in situ keratomileusis on his right eye was reported. He suffered from an incomplete corneal flap cut as complication during the surgical procedure, and a diffuse lamellar keratitis was detected at the immediate postsurgical visit. Total visual recovery and the refractive defect stability were attained through local treatment. This allows further correcting the defect by means of a surface refractive surgery in the future
Subject(s)
Humans , Male , Adult , Keratitis/complications , Keratitis/drug therapy , Keratomileusis, Laser In Situ/adverse effects , Case ReportsABSTRACT
OBJETIVO: Describir el comportamiento de la queratitis lamelar difusa como complicación después de emplear la técnica quirúrgica queratomileusis in situ con láser. MÉTODOS: Se realizó un estudio descriptivo, de corte transversal en el Servicio de Cirugía Refractiva Corneal del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" en el último trimestre del año 2008. La muestra quedó conformada por 16 ojos a los que se les realizó la queratomileusis in situ con láser como técnica quirúrgica para corregir ametropía y que presentaron complicaciones con esta cirugía. Se analizaron variables como la agudeza visual sin corrección; los ojos con esta complicación fueron analizados según la clasificación de Linebarger. RESULTADOS: La frecuencia de queratitis lamelar difusa fue de 3,0 por cada 100. La agudeza visual no corregida se comportó entre 0,8 y 1,0 en 12 ojos de 16 afectados, el estadio 1 se presentó en 12 ojos. CONCLUSIONES: La queratitis lamelar difusa es una complicación poco frecuente, los casos que la padecieron alcanzaron una buena agudeza visual final sin corrección. Predominó la forma leve de este cuadro.
OBJECTIVE: To describe the situation of Diffuse lamellar keratitis as a complication after in situ keratomileusis with laser. METHODS: A descriptive cross-sectional study was carried out in the Refractive Corneal Service of "Ramón Pando Ferrer" Cuban Institute of Ophthalmology during the last quarter of 2008. The sample embraced 16 eyes that underwent in situ keratomileusis plus laser as the refractive procedure to correct ametropy and presented with some complications. Visual acuity without correction was one the analyzed variables and the eyes with this type of complication were classified according to Linebarger´s classification. RESULTS: The diffuse lamellar keratitis frequency was 3.0 per one hundred cases, the visual acuity without correction was 0.8 to 1.0 in 12 out of 16 eyes whereas stage 1 was present in 12 eyes as well. CONCLUSIONS: The diffuse lamellar keratitis is a rare complication. The patients reached good final visual acuity without correction. Slight form of this complication prevailed.
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AIM: To report a case of late onset diffuse lamellar keratitis (DLK) after laser in situ keratomileusis(LASIK) in 11 months due to corneal trauma. ·METHODS: A 22-year-old female patient underwent uneventful bilateral LASIK using a laserSight SLX excimer laser and Moria II microkeratome. No complications were observed during the operation and the early postoperative period.·RESULTS: 11 months after LASIK, grade I DLK was diagnosed after the book paper hurt the right corneal epithelium. The DLK responded rapidly to topical corticosteroid therapy, and healed in 2 weeks without complication. ·CONCLUSION: Although DLK Wpically develops in the early postoperative period, it could occur months after surgery. Treatment should begin as soon as DLK is diagnosed.
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PURPOSE: To evaluate visual outcome and the changes of contrast sensitivity (CS) after diffuse lamellar keratitis (DLK). METHODS: Using retrospective chart review, 48 eyes of 25 patients who underwent laser in situ keratomileusis (LASIK) with Visx S4 (VISX Inc., Santa Clara, CA) and M2 (Moria, France) and who were followed for at least six months were included. They were divided into two groups: DLK and non-DLK, by diagnosis of DLK or its absence after LASIK. Postoperative logMAR visual acuities and logCS measured using the VCTS(R) 6500 (Vistech Consultants, Inc., Dayton, OH) were compared with preoperative values in the DLK and non-DLK groups at three and six months after LASIK. RESULTS: There was no difference in logMAR visual acuity between the DLK and non-DLK groups until the sixth postoperative month. However, CS was significantly decreased at 12 and 18 cycle/degree compared with preoperative values (p=0.043 and p=0.045, respectively) in the DLK group, whereas CS was significantly increased at 12 cycle/degree in the non-DLK group (p=0.042) at six months. CONCLUSIONS: DLK seemed to be strongly associated with a postoperative decrease of CS.
Subject(s)
Humans , Adult , Visual Acuity , Retrospective Studies , Keratomileusis, Laser In Situ/adverse effects , Keratitis/etiology , Contrast SensitivityABSTRACT
Objectives: To observe the clinical course of diffuse lamellar keratitis(DLK) after laser in situ keratomileusis(LASIK) and to investigate the presentation and management of DLK. Methods:Among 3500 patients underwent LASIK in our center, 18 eyes in 10 patients received DLK were examined. All eyes were examined with slitlamp biomicroscope at the course of 3 days,7 days,14 days,1 month, 2 months and 6 months after the operation. Visual actuity was measured. Results:Symptoms were controlled after 1 week treatment of topical corticosteroids and antibiotics. Resolution of DLK occurred after 1 to 2 months. Uncorrected visual acuity is 1.0 to 1.5 in 16 eyes and 0.8 to 1.0 in 2 eyes. Conclusions:DLK is a complication after LASIK, it usually occurs in 1 to 7 days postoperatively, more likely in male. Topical corticosteroids and antibiotics can get a satisfied outcome. Systemic corticosteroids and antibiotics are needed in serious cases. Early stage of DLK must be distinguished from corneal epithelial implantation and interface infection.
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We experienced 5 cases of diffuse lamellar keratitis or Sands of the Sahara syndrome, which have not been reported in Korea. Patients complained of blurred vision or ocular discomfort 1 or 2 days after LASIK. They showed diffuse infiltrates confined to the flap interface with no posterior or anterior extension and had no anterior chamber reaction. The diffuse infiltrates responded well to steroid or antibiotic/steroid eyedrops showing diminution of infiltrates within 3 to 4 days of therapy. The best corrective visual acuities were 0.8 to 1. 0 around 1 month after surgery.