Diffuse lamellar keratitis induced by toxic chemicals after laser in situ keratomileusis.
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.
Shen
Ying-Cheng
YC
Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China. eric550131@yahoo.com.tw
Wang
Chun-Yuan
CY
Fong
Shih-Chao
SC
Tsai
Hin-Yeung
HY
Lee
Yi-Fen
YF
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
D005938:Glucocorticoids; C009935:prednisolone acetate; D011239:Prednisolone