Corneal flap complications in refractive surgery: Part 2: postoperative treatments of diffuse lamellar keratitis in an experimental animal model.
OBJECTIVE
To induce diffuse lamellar keratitis (DLK) and investigate a prophylactic treatment with pharmacological agents.


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


METHODS
In 100 eyes of 50 Dutch Belted rabbits, a nasal corneal flap was cut and the interface inoculated with Pseudomonas aeruginosa lipopolysaccharide endotoxin (n = 50) or Palmolive Ultra soap (n = 50). The eyes were randomly assigned to treatment with a mast-cell stabilizer, a nonsteroidal antiinflammatory drug (NSAID), a fluoroquinolone antibiotic agent, a corticosteroid, or left without treatment as a control. Slitlamp examinations and photographs were performed 1, 3, 5, and 7 days postoperatively, and DLK was graded by a masked observer from 0 (no DLK) to stage 4.


RESULTS
At the end of the study, 80 eyes were available for evaluation. Ninety-four percent of the untreated eyes developed DLK compared to 56% of eyes treated with NSAIDs and 63% of eyes treated with steroids (P<.05, Fisher exact test). The DLK rates with the mast-cell stabilizer and fluoroquinolone antibiotic agent were 86% and 76%, respectively. The DLK incidence in the latter 2 groups was not significantly different from that in the control eyes (P>.05, Fisher exact test).


CONCLUSIONS
Postoperative prophylactic treatment with NSAIDs and corticosteroids led to a statistically significantly lower incidence of postoperative DLK. The study demonstrated that corticosteroids and NSAIDs can be used to treat DLK after LASIK. While steroids are a generally accepted treatment for DLK, NSAIDS may offer an additional potent modality.
Holzer
Mike P
MP
Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston 29425, USA.
Sandoval
Helga P
HP
Vargas
Luis G
LG
Kasper
Terrance J
TJ
Vroman
David T
DT
Apple
David J
DJ
Solomon
Kerry D
KD
D000818:Animals; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D003319:Corneal Stroma / Q000601:surgery; D004195:Disease Models, Animal; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D007634:Keratitis / Q000188:drug therapy* / Q000209:etiology; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects; D020911:Ketorolac Tromethamine / Q000008:administration & dosage / Q000627:therapeutic use; D008070:Lipopolysaccharides; D017835:Nedocromil / Q000008:administration & dosage / Q000627:therapeutic use; D015242:Ofloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D009883:Ophthalmic Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011550:Pseudomonas aeruginosa; D011817:Rabbits; D054140:Refractive Surgical Procedures; D013524:Surgical Flaps / Q000009:adverse effects*
D000890:Anti-Infective Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D008070:Lipopolysaccharides; D009883:Ophthalmic Solutions; D017835:Nedocromil; D020911:Ketorolac Tromethamine; C009935:prednisolone acetate; D011239:Prednisolone; D015242:Ofloxacin