LASIK interface keratitis: epidemiology, diagnosis and care

Gritz, David C.

doi:10.1097/icu.0b013e3283477b52

Cited by 40 publications

(28 citation statements)

References 67 publications

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“…19 This non-specific interface inflammation is certainly associated with intraoperative epithelial defects, 20 and has been linked to multiple rare potential inciting factors. 21 However, the majority of cases, especially DLK epidemics, can be linked to bacterial endotoxins, especially in sterilization reservoirs 3, 22–26 or issues during the instrument sterilization process. 27, 28 Isolated idiopathic DLK cases occur sporadically, 29 however, if more than one case occurs in a short time, steps should be undertaken to evaluate the sterilization process.…”

Section: Diffuse Lamellar Keratitis (Dlk)mentioning

confidence: 99%

LASIK Interface Complications: Etiology, Management, and Outcomes

Randleman

Shah²

2012

J Refract Surg

112

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The anatomy of the LASIK interface allows for a variety of potential complications to arise, unique etiologies with overlapping clinical presentations. Primary interface complications include infectious keratitis, diffuse lamellar keratitis (DLK), central toxic keratopathy (CTK), pressure-induced stromal keratopathy (PISK), and epithelial ingrowth. Infectious keratitis is most commonly caused by Methicill in resistant S. aureus (early onset) or atypical Mycobacterium (late onset) postoperatively, and immediate treatment includes flap lift and irrigation, cultures, and initiation of broad-spectrum topical antibiotics, with possible flap amputation for recalcitrant cases. DLK is a white blood cell infiltrate that appears within the first 5 days postoperatively and is acutely responsive to aggressive topical and oral steroid use in the early stages but may require flap lift and irrigation to prevent flap necrosis if inflammation worsens. In contrast, PISK is caused by acute steroid response and resolves only with cessation of steroid use and IOP lowering. Without appropriate therapy PISK can result in severe optic nerve damage. CTK mimics stage 4 DLK but occurs early in the postoperative period is non-inflammatory. Observation is the only effective treatment, and flap lift is usually not warranted. Epithelial ingrowth is easily distinguishable from other interface complications and may be self-limited or require flap lift to treat irregular astigmatism and prevent flap melt. Differentiating between interface entities is critical to rapid appropriate diagnosis, treatment, and ultimate visual outcome. While initial presentations may overlap significantly, the conditions can be readily distinguished with close follow-up and most complications can resolve without significant visual sequelae when treated appropriately.

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Section: Diffuse Lamellar Keratitis (Dlk)mentioning

confidence: 99%

LASIK Interface Complications: Etiology, Management, and Outcomes

Randleman

Shah²

2012

J Refract Surg

112

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“…DLK presents as granular inflammatory cell deposits within the LASIK interface, usually showing a wave-like appearance 1. It most often presents during the first postoperative week, although late-onset DLK cases have been reported in post-LASIK cases related with trauma, epithelial defects or other inflammatory or infectious conditions.…”

Section: Differential Diagnosismentioning

confidence: 99%

Post-LASIK edema-induced keratopathy (PLEK), a new name based on pathophysiology of the condition

et al. 2012

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A 33-year-old man who underwent uneventful laser in situ keratomileusis (LASIK) developed pressure-induced stromal edema resulting in an interface haze in both eyes and a pocket of fluid under the flap of the right eye 10 days after surgery, while receiving topical fluorometholone. Intraocular pressure by applanation tonometry was 16 mm Hg in his right eye (erroneous result due to the fluid in the interface) and 34 mm Hg in his left eye. After discontinuation of steroids and addition of ocular hypotensive medication, interface fluid collection disappeared in his right eye. Visual acuity improved and haze diminished in both eyes. This case illustrates that in the same patient a post-LASIK edema induced syndrome may be present with or without fluid in the interface, suggesting that both clinical pictures could be manifestations of a broad spectrum of the same condition. We suggest a new name for this non-inflammatory disorder: post-LASIK edema-induced keratopathy (PLEK).

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“…DLK is a common complication of LASIK surgery, since the creation of a flap provides a space in which cells are able to accumulate (7). DLK is characterized by diffused white, granular infiltrate around the edge of the corneal flap (7) and typically occurs within a few days after LASIK surgery.…”

Section: Discussionmentioning

confidence: 99%

Bilateral diffuse lamellar keratitis triggered by permanent eyeliner tattoo treatment: A case report

Liu

Zhou

et al. 2017

Experimental and Therapeutic Medicine

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Diffuse lamellar keratitis (DLK) is a sterile inflammation of the cornea, which may occur after laser-assisted in situ keratomileusis (LASIK) surgery. Little is known about the association of DLK with permanent eyeliner tattoo. The present case report describes the case of a 37-year-old Chinese woman who developed severe foreign body sensation in both eyes 1 week after receiving bilateral permanent eyeliner tattoo treatment. The patient had received bilateral LASIK surgery 10 years previously. Slit-lamp biomicroscopy revealed diffused granular infiltrates precipitated around the edge of the corneal flaps in both eyes. After topical treatment, DLK persisted. Therefore, the patient underwent surgery to remove the corneal epithelium around the DLK lesion. There was no recurrence of the disease during the 3-month observation period. To our knowledge, this is the first case report describing a case of late-onset of DLK that was triggered by permanent eyeliner tattoo. Doctors should be aware of the diagnosis and treatment of this complication associated with the application of permanent eyeliner tattoo as the popularity of this cosmetic procedure increases.

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LASIK interface keratitis: epidemiology, diagnosis and care

Cited by 40 publications

References 67 publications

LASIK Interface Complications: Etiology, Management, and Outcomes

LASIK Interface Complications: Etiology, Management, and Outcomes

Post-LASIK edema-induced keratopathy (PLEK), a new name based on pathophysiology of the condition

Bilateral diffuse lamellar keratitis triggered by permanent eyeliner tattoo treatment: A case report

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