Ophthalmology Research Today is a free monthly online journal that collates and summarizes the latest research about Ophthalmology, including details on eye surgery, myopia, cataracts.

Diffuse lamellar keratitis induced by toxic chemicals after laser in situ keratomileusis.

Shen YC, Wang CY, Fong SC, Tsai HY, Lee YF

Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China. eric550131@yahoo.com.tw

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.

Published 21 July 2006 in J Cataract Refract Surg, 32(7): 1146-50.
Full-text of this article is available online (may require subscription).

© 2005-2008 Ophthalmology Research Today. All Rights Reserved.