Diffuse lamellar keratitis: evaluation of etiology, histopathologic findings, and clinical implications in an experimental animal model.
OBJECTIVE
To induce diffuse lamellar keratitis (DLK) and investigate the potential causative agents in an animal model.


METHODS
Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.


METHODS
In 70 eyes of 35 Dutch Belted rabbits, a corneal flap was cut and the interface randomly exposed to 1 of 7 substances: Pseudomonas aeruginosa endotoxin, 1 of 2 Staphylococcus aureus exotoxins, meibomian gland secretion, povidone-iodine 10%, Palmolive Ultra soap, and Klenzyme soap. Slitlamp examinations were performed 1, 3, 5, and 7 days postoperatively. The DLK was staged from 1 to 4. On day 7, the rabbits were killed and the eyes enucleated and processed for histopathologic examination.


RESULTS
At the end of the study, 54 eyes (46 exposed, 8 control) were available for evaluation. The 8 eyes studied concurrently in the control group remained clear and did not show interface inflammation. Thirty-one of 46 eyes (67%) treated with the various test substances developed DLK. The highest DLK rates were found with the cleaning soap Palmolive Ultra (100%; P =.022) and P. aeruginosa lipopolysaccharide endotoxin (90%; P =.026).


CONCLUSIONS
Interface inflammation was consistently induced in the animal model. All 7 agents caused DLK in at least some eyes. The histopathologic evaluation showed the morphologic profile of the marked inflammatory cellular reaction that occurred in almost all the specimens.
Holzer
Mike P
MP
Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Solomon
Kerry D
KD
Vroman
David T
DT
Vargas
Luis G
LG
Sandoval
Helga P
HP
Kasper
Terrance J
TJ
Apple
David J
DJ
D000818:Animals; D001685:Biological Factors / Q000494:pharmacology*; D012634:Bodily Secretions / Q000502:physiology; D003319:Corneal Stroma / Q000187:drug effects* / Q000473:pathology; D005098:Exotoxins / Q000009:adverse effects; D005260:Female; D007634:Keratitis / Q000139:chemically induced* / Q000473:pathology*; D008070:Lipopolysaccharides / Q000009:adverse effects; D008537:Meibomian Glands / Q000378:metabolism; D023421:Models, Animal; D011206:Povidone-Iodine / Q000009:adverse effects; D011550:Pseudomonas aeruginosa; D011817:Rabbits; D012915:Soaps / Q000009:adverse effects; D013211:Staphylococcus aureus; D013524:Surgical Flaps
D001685:Biological Factors; D005098:Exotoxins; D008070:Lipopolysaccharides; D012915:Soaps; D011206:Povidone-Iodine