title: Diffuse lamellar keratitis induced by toxic chemicals after laser in situ keratomileusis.
abstract: OBJECTIVE
  To assess whether toxic chemicals produced during autoclaving sterilization were 1 of the main causes of diffuse lamellar keratitis (DLK) and to analyze the clinical outcomes of patients developing DLK after laser in situ keratomileusis (LASIK) treated with intensive topical corticosteroids.
  
  
  METHODS
  Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
  
  
  METHODS
  A total of 14 eyes of 7 patients received technically smooth LASIK and developed DLK, including 6 severe and 8 mild DLK cases. In all eyes the same microkeratome was used; it was contaminated with toxic chemical materials produced accidentally by coautoclaving instruments and a foam piece.
  
  
  RESULTS
  Six eyes of 3 patients developed severe DLK on the same day, and 8 eyes of 4 patients developed mild DLK during the next LASIK surgery. After intensive topical corticosteroid treatment, lamellar infiltrates disappeared in 3 days in mild DLK eyes and 2 weeks in severe DLK eyes. No eye was treated with flap lifting and interface irrigation. For grade 4 DLK, the corneal opacity and flap folds disappeared in 4 weeks. There were no instances of permanent corneal scarring or loss of best spectacle-corrected visual acuity.
  
  
  CONCLUSIONS
  Toxic chemicals produced during instrument autoclaving sterilization are a possible cause of DLK. Immediate diagnosis and treatment with intensive corticosteroid drops are critical and can resolve severe DLK.
authors.affiliation: Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China. eric550131@yahoo.com.tw
authors.forename: Ying-Cheng
authors.initials: YC
authors.lastname: Shen
authors.forename: Chun-Yuan
authors.initials: CY
authors.lastname: Wang
authors.forename: Shih-Chao
authors.initials: SC
authors.lastname: Fong
authors.forename: Hin-Yeung
authors.initials: HY
authors.lastname: Tsai
authors.forename: Yi-Fen
authors.initials: YF
authors.lastname: Lee
mesh_terms: D000328:Adult; D003319:Corneal Stroma / Q000601:surgery; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007634:Keratitis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D020731:Keratomileusis, Laser In Situ / Q000295:instrumentation*; D009216:Myopia / Q000601:surgery*; D011183:Postoperative Complications; D011239:Prednisolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D013242:Sterilization; D013524:Surgical Flaps
chemical_list: D005938:Glucocorticoids; C009935:prednisolone acetate; D011239:Prednisolone