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  • Title: Diffuse lamellar keratitis induced by toxic chemicals after laser in situ keratomileusis.
    Author: Shen YC, Wang CY, Fong SC, Tsai HY, Lee YF.
    Journal: J Cataract Refract Surg; 2006 Jul; 32(7):1146-50. PubMed ID: 16857501.
    Abstract:
    PURPOSE: To assess whether toxic chemicals produced during autoclaving sterilization were 1 of the main causes of diffuse lamellar keratitis (DLK) and to analyze the clinical outcomes of patients developing DLK after laser in situ keratomileusis (LASIK) treated with intensive topical corticosteroids. SETTING: Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China. METHODS: A total of 14 eyes of 7 patients received technically smooth LASIK and developed DLK, including 6 severe and 8 mild DLK cases. In all eyes the same microkeratome was used; it was contaminated with toxic chemical materials produced accidentally by coautoclaving instruments and a foam piece. RESULTS: Six eyes of 3 patients developed severe DLK on the same day, and 8 eyes of 4 patients developed mild DLK during the next LASIK surgery. After intensive topical corticosteroid treatment, lamellar infiltrates disappeared in 3 days in mild DLK eyes and 2 weeks in severe DLK eyes. No eye was treated with flap lifting and interface irrigation. For grade 4 DLK, the corneal opacity and flap folds disappeared in 4 weeks. There were no instances of permanent corneal scarring or loss of best spectacle-corrected visual acuity. CONCLUSIONS: Toxic chemicals produced during instrument autoclaving sterilization are a possible cause of DLK. Immediate diagnosis and treatment with intensive corticosteroid drops are critical and can resolve severe DLK.
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