Purpose: To investigate the inciting agent, clinical features, and the efficacy of hourly steroids in the prophylaxis in a diffuse lamellar keratitis (DLK) epidemic. Methods: One hundred and five eyes of 58 patients that had DLK after LASIK were included in the study. To identify the cause of the epidemic, some interventions were made: irrigation solution was changed from BSS to Ringer lactate (week 5), wiping of the interface with a sponge was discontinued (week 6), the air conditioner in the LASIK room was checked (week 6), the routine postoperative topical regimen was changed from fluoromethalone and fluoroquinolones 4 times a day to hourly prednisolone acetate or dexamethasone sodium and fluoroquinolones (week 7), and the trademark of the drape used was changed (week 12). Results: There was no statistical difference in any of the attack rates associated with variables including BSS versus Ringer lactate (9.9 vs. 14%, p = 0.4), and air conditioner check with wiping versus not wiping the interface with the microsurgical sponge (14.0 vs. 18.2%, p = 0.6). There was a significant decrease in the attack rate from 18.2 to 5.3% with use of the hourly prophylactic topical steroids (p = 0.012). After introduction of a new trademark of the drape, the incidence of DLK was further reduced from 5.3 to 0.7% (p = 0.016). Conclusion: The cause in a particular DLK epidemic should be identified and eliminated adopting a scientific approach. Hourly steroid use for prophylaxis is recommended until the etiologic agent responsible has been identified.

Keywords:
Diffuse lamellar keratitis, Drape, BSS, Steroids, prophylactic, Steroid response glaucoma, Interface opacities, dot-like
1.
Smith RJ, Maloney RK: Diffuse lamellar keratitis, a new syndrome in lamellar refractive surgery. Ophthalmology 1998;105:1721–1726.
2.
Lin RT, Maloney RK: Flap complications associated with lamellar refractive surgery. Am J Ophthalmol 1999;127:129–136.
3.
Stulting RD, Carr JD, Thompson KP, Waring GO, Wiley WM, Walker JG: Complications of laser in situ keratomileusis for the correction of myopia. Ophthalmology 1999;106:13–20.
4.
Yuhan KR, Nguyen L, Wachler BSB: Role of instrument cleaning and maintenance in the development of diffuse lamellar keratitis. Ophthalmology 2002;109:400–404.
5.
Alio JL, Perez-Santomja J, Tervo T, et al: Postoperative inflammation, microbial complications, and wound healing following laser in situ keratomileusis. J Refract Surg 2000;16:523–538.
6.
Holland SP, Mathias RG, Morck DW, Chiu J, Slade SG: Diffuse lamellar keratitis related to endotoxins released from sterilizer reservoir biofilms. Ophthalmology 2000;107:1227–1234.
7.
Linebarger EJ, Hardten DR, Lindstrom RL: Diffuse lamellar keratitis: Identification and management. J Cataract Refract Surg 2000;26:1072–1077.
8.
Johnson JD, Harissi-Dagher M, Pineda R, Yoo S, Azar DT: Diffuse lamellar keratitis: Incidence, associations, outcomes, and a new classification system. J Cataract Refract Surg 2001;27:1560–1566.
9.
Peters NT, Lingua RW, Kim CH: Topical intrastromal steroid during laser in situ keratomileusis to retard interface keratitis. J Cataract Refract Surg 1999;25:1437–1440.
10.
Holland SP: Update in cornea and external disease: Solving the mystery of ‘sands of the Sahara’ syndrome (diffuse lamellar keratitis). Can J Ophthalmol 1999;34:193–194.
11.
Lachance A, Tremblay M: The sands of the Sahara. Can J Ophthalmol 1998;33:387–388.
12.
Melki SA, Azar DT: LASIK complications: Etiology, management, and prevention. Surv Ophthalmol 2001;46:95–116.
13.
MacRae SM, Rich LF, Macaluso DC: Treatment of interface keratitis with oral corticosteroids. J Cataract Refract Surg 2002;28:454–461.
14.
Shah MN, Misra M, Wihelmus KR, Koch DD: Diffuse lamellar keratitis associated with epithelial defects after laser in situ keratomileusis. J Cataract Refract Surg 2000;26:1312–1318.
15.
Lyle WA, Jin GJ: Interface fluid associated with diffuse lamellar keratitis and epithelial ingrowth after laser in situ keratomileusis. J Cataract Refract Surg 1999;25:1009–1012.
16.
Parolini B, Marcon G, Giacomo AP: Central necrotic lamellar inflammation after laser in situ keratomileusis. J Cataract Refract Surg 2001;17:110–112.
© 2004 S. Karger AG, Basel
2004
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