[Clinical study of diffuse lamellar keratitis after laser in situ keratomileusis].
OBJECTIVE
To investigate a new clinical grading scale of diffuse lamellar keratitis (DLK) following laser in situ keratomileusis (LASIK) and to observe the clinic outcomes of eyes treated with corresponding classified therapy.


METHODS
It was a prospective case-control study. Eyes that developed DLK after LASIK were diagnosed by a new criterion of clinical grading scale based on both severity and scope of inflammatory cells infiltrations in the corneal interface. Dose and frequency of topical or systemic corticosteroid were determined by the classified profiles according to each grade. Clinical symptoms, corneal inflammatory cells infiltrations, visual acuity, refractive error and intraocular pressure (IOP) were evaluated on 1, 3, 5, 7, 10 days and 1 month after diagnosis as well as at the time of diagnosis.


RESULTS
Among the 35 eyes of 29 patients that developed DLK, mild inflammatory cells infiltrations were mostly seen. Thirty eyes had degree I DLK and 3 had degree II DLK. One eye had degree III DLK and one had degree IV DLK. Inflammatory cells infiltrations in 20 eyes invaded peripheral zone (zone 1) and those in 11 eyes invaded mid-peripheral zone (zone 2). Inflammatory cells infiltrates in 4 eyes invaded central zone (zone 3). Nineteen eyes had degree I zone 1 DLK. Thirty three eyes were diagnosed between the 1st day and the 3rd day after surgery. Uncorrected visual acuity (UCVA) was worse than preoperative best spectacle corrected visual acuity (BSCVA). Inflammatory cells infiltrations retreated within 6.06 2.04 days after classified corticosteroid therapy. One month after the treatment, UCVA had improved to the level of preoperative BSCVA. BSCVA in 30 eyes were equal to or better than those before surgery. Spherical equivalent of the refractive error was (-0.21 +/- 1.16) D. There was no statistic difference in the retreat time of inflammatory cells infiltrations, recovery of visual acuity and refractive error among the different grades of DLK or among the DLK treated with different therapy profiles. No eye suffered from high intraocular pressure during the treatments.


CONCLUSIONS
Clinical grading scale and corresponding classified therapy were proved to be effective in the treatment for DLK.
Yao
Pei-Jun
PJ
Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Myopia Key Lab of Health Ministry, Shanghai 200031, China.
Zhou
Xing-Tao
XT
Chu
Ren-Yuan
RY
Miao
Ai-Zhu
AZ
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000209:etiology*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008875:Middle Aged; D009216:Myopia / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology*; D011446:Prospective Studies; D055815:Young Adult
D005938:Glucocorticoids