Diffuse lamellar keratitis: Incidence, associations, outcomes, and a new classification system
- 1 October 2001
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Cataract & Refractive Surgery
- Vol. 27 (10), 1560-1566
- https://doi.org/10.1016/s0886-3350(01)00958-0
Abstract
Purpose: To evaluate the incidence, associations, and visual outcomes in patients with diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK). Setting: University-based refractive surgery center, Boston, Massachusetts, USA. Methods: This retrospective review comprised 2711 eyes that had LASIK between September 1996 and September 1999. All eyes that developed DLK after LASIK were included. They were divided into type I DLK (center sparing) or type II DLK (center involved) and then subdivided into A (sporadic—DLK not diagnosed in other patients treated on the same day) or B (cluster—other patients identified with DLK). Type IA corresponded to center sparing, sporadic; type IB, center sparing, cluster; type IIA, center involved, sporadic; and type IIB, center involved, cluster. The main outcome measures were incidence of DLK after LASIK, time to diagnosis, time to resolution, and changes in best spectacle-corrected visual acuity (BSCVA). Unpaired t tests were used for statistical analyses. Results: Thirty-six eyes (1.3%) developed DLK. Type I occurred in 58.3% of cases (type IA, n = 18; type IB, n = 3) and type II, in 41.7% (type IIA, n = 10; type IIB, n = 5). The mean time to diagnosis was not statistically significantly different between type I (1.8 days) and type II (1.1 days). Fourteen eyes (38.9%) developed DLK after an epithelial defect, representing an odds ratio of 13 times. The association with an epithelial defect was statistically significantly greater with type I (11/21 eyes, 52.4%) than with type II (3/15 eyes, 20.0%; P = .05). The mean time to resolution was 3.5 days in type I (type IA = 3.6 days; type IB = 2.7 days). This was significantly shorter than in type II, which had a mean time to resolution of 12.1 days (type IIA = 9.3 days; type IIB = 10.2 days) (P = .001). Loss of 2 or more lines of BSCVA occurred in 2 of 5 patients with type IIB and in no patients with types IA, IB, or IIA. Conclusions: Epithelial defects after LASIK increased the risk of DLK occurrence, especially type I. Type II DLK was associated with a prolonged time to resolution and carried a significantly higher risk of BSCVA loss than type I.Keywords
This publication has 12 references indexed in Scilit:
- Diffuse lamellar keratitis associated with epithelial defects after laser in situ keratomileusisJournal of Cataract & Refractive Surgery, 2000
- Optical Disturbances and Their Management After Myopic Laser In Situ KeratomileusisInternational Ophthalmology Clinics, 2000
- Complications of laser in situ keratomileusis for the correction of myopiaOphthalmology, 1999
- Interface inflammation after laser in situ keratomileusisJournal of Cataract & Refractive Surgery, 1998
- Interface keratitis-induced stromal thinning: An early postoperative complication of laser in situ keratomileusisJournal of Cataract & Refractive Surgery, 1998
- Diffuse lamellar keratitis A new syndrome in lamellar refractive surgeryOphthalmology, 1998
- Laser in situ keratomileusis: Literature review of a developing techniqueJournal of Cataract & Refractive Surgery, 1998
- Indications, techniques, results, limits, and complications of laser in situ photoabl keratomileusisCurrent Opinion in Opthalmology, 1997
- Selected Complications of Radial Keratotomy, Photorefractive Keratectomy, and Laser In Situ KeratomileusisInternational Ophthalmology Clinics, 1997
- Experience during the learning curve of laser in situ keratomileusisJournal of Cataract & Refractive Surgery, 1996