Address of Corresponding Author

Ophthalmologica 2004;218:318-322 (DOI: 10.1159/000079473)

  Key Words

• Diffuse lamellar keratitis
• Drape
• BSS
• Steroids, prophylactic
• Steroid response glaucoma
• Interface opacities, dot-like

  Abstract

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.

Copyright © 2004 S. Karger AG, Basel

  Author Contacts

C. Banu Cosar, MD
Sinpas Aqua City 1. Etap
H Blok D: 28
Cekmekoy, TR-80260 Istanbul (Turkey)
Tel. +90 216 6123856, Fax +90 212 2829290, E-Mail cbcosar@yahoo.com

  Article Information

The authors have no financial interest in this research.

Received: July 31, 2003
Accepted after revision: January 16, 2004
Number of Print Pages : 5
Number of Figures : 3, Number of Tables : 0, Number of References : 16