title: Refractive outcomes and quality of vision related to an outbreak of diffuse lamellar keratitis.
abstract: OBJECTIVE
  To report the impact on visual function and corneal aberrations during an epidemic of diffuse lamellar keratitis (DLK).
  
  
  METHODS
  A retrospective, comparative, and consecutive case-control study was performed, involving 418 eyes operated between March and October 2007 in the refractive surgery unit of one center. Eyes were separated into groups: group 1 (DLK group) included 209 eyes that presented with DLK after LASIK and group 2 (control group) included 209 unaffected, consecutive eyes operated from the beginning of the outbreak. Refractive variables and corneal aberrations were compared between the two groups.
  
  
  RESULTS
  Visual outcomes were significantly different when comparing control eyes and eyes with DLK grades 3 and 4, but not for eyes with DLK grades 1 and 2. Uncorrected distance visual acuity (UDVA) significantly improved from the third month after DLK was diagnosed (Kruskal-Wallis, P=.02). Corrected distance visual acuity (CDVA) did not decrease significantly with DLK grades 1 and 2 (preoperative CDVA vs 1, 3, and 6 months after diagnosis; Mann-Whitney, P>.05, respectively). At the end of follow-up, UDVA and CDVA were not significantly different between the two groups. Eyes suffering from DLK had significantly increased corneal aberrations, except for spherical and astigmatism aberrations, 3 months after being diagnosed (Kruskal-Wallis, P<.05); however, corneal aberrations were not significantly different between the DLK and control groups (Mann-Whitney, P>.05).
  
  
  CONCLUSIONS
  The outbreak of DLK did not induce a significant decrease in global visual outcomes, except in severe cases, and postoperative corneal aberrations were not affected.
authors.affiliation: Department of Refractive Surgery, Instituto Oftalmológico de Alicante, Vissum, Spain. jjavaloy@coma.es
authors.forename: Jaime
authors.initials: J
authors.lastname: Javaloy
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Alió
authors.forename: Bassam
authors.initials: B
authors.lastname: El Kady
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Muñoz
authors.forename: Rafael I
authors.initials: RI
authors.lastname: Barraquer
authors.forename: Miguel J
authors.initials: MJ
authors.lastname: Maldonado
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000601:surgery; D016022:Case-Control Studies; D057108:Corneal Wavefront Aberration / Q000503:physiopathology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000601:surgery; D007634:Keratitis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects; D054018:Lasers, Excimer / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult