title: Diffuse lamellar keratitis associated with epithelial defects after laser in situ keratomileusis.
abstract: OBJECTIVE
  To describe the association between the presence of epithelial defects and the development of diffuse lamellar keratitis (DLK), "Sands of the Sahara" syndrome, following laser in situ keratomileusis (LASIK).
  
  
  METHODS
  Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
  
  
  METHODS
  In this retrospective study, the postoperative clinical course and surgical outcomes in 735 eyes of 358 consecutive patients who had myopic LASIK between December 1998 and August 1999 were reviewed. Of the 735 procedures, 680 were primary LASIK procedures and 55 were retreatments performed by lifting the existing flaps. The incidence and severity of DLK and the relationship of DLK to epithelial defects were tabulated.
  
  
  RESULTS
  Diffuse lamellar keratitis developed in 9 of the 16 eyes that had postoperative epithelial defects. Seventeen eyes without epithelial defects also developed DLK. The presence of an epithelial defect increased an individual's risk of developing DLK 24 times (95% confidence interval, 13 to 45). In 8 eyes, the inflammation resolved following treatment with intense topical corticosteroids. One eye had irrigation under the flap because of dense central inflammation; the final outcome was mild inferior corneal steepening. All eyes recovered preoperative best spectacle-corrected visual acuities.
  
  
  CONCLUSIONS
  Patients who have epithelial defects of any size following LASIK are at significantly increased risk of developing DLK.
authors.affiliation: Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: M N
authors.initials: MN
authors.lastname: Shah
authors.forename: M
authors.initials: M
authors.lastname: Misra
authors.forename: K R
authors.initials: KR
authors.lastname: Wihelmus
authors.forename: D D
authors.initials: DD
authors.lastname: Koch
mesh_terms: D000328:Adult; D019781:Corneal Topography; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery; D009883:Ophthalmic Solutions; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011355:Prodrugs / Q000008:administration & dosage*; D012189:Retrospective Studies; D014792:Visual Acuity
chemical_list: D009883:Ophthalmic Solutions; D011355:Prodrugs; C009935:prednisolone acetate; D011239:Prednisolone