Eyeworld

20 | EYEWORLD | MARCH 2021 by Nhon Le, MD, Margaret Wang, MD, Rohini Sigireddi, MD, Zaina Al-Mohtaseb, MD, and Mitchell Weikert, MD contamination, including single-use instru- ments, powderless gloves, and the avoidance of corneal marking. The Technolas 217P or Technolas 317 Teneo excimer laser (Bausch + Lomb) was used for the refractive ablation. Postoperatively, patients were followed for at least 6 months. Standard DLK grading, first described by Linebarger, was used. 15 Summary of results Incidence Of the 37,315 eyes (of 19,602 patients), DLK was observed in 236 eyes (0.63%) in 149 patients (0.76%). Grade 1 DLK occurred in 231 eyes (0.62%). Grade 2 DLK occurred in one eye of a single patient. Grade 3 DLK was observed in both eyes of one patient (patient 1) and one eye of another patient (patient 2). Grade 4 DLK was seen in a total of five eyes of three patients (patient 1, bilateral grade 3 DLK that progressed to bilateral grade 4 disease; patient 2, right eye; patient 3, both eyes). Among the 1,889 patients who underwent unilateral LASIK, DLK was observed in 12 (0.63%) patients. Among the 17,713 patients who underwent bilateral LASIK, DLK was observed in 137 (0.77%) patients. Grade 2–4 DLK was only seen ASCRS/EYEWORLD JOURNAL CLUB ASCRS NEWS Review of "Diffuse lamellar keratitis after LASIK with low-energy femtosecond laser" L aser-assisted in situ keratomileusis (LASIK) is a refractive procedure involv- ing the creation of a thin corneal flap with a microkeratome or femtosecond laser followed by excimer laser ablation to reshape the cornea. While LASIK is a low-risk procedure, diffuse lamellar keratitis (DLK)—a potentially devastating complication—can occur. DLK is a non-infectious, inflammatory response characterized by fine, white, inflammatory infil- trates beneath the corneal flap. 1 The incidence of DLK after microkeratome and femtosecond LASIK is estimated to be between 0.4–7.7% and 0.4–37.5%, respectively. 1–7 The mechanism of DLK is not fully understood but has been as- cribed to debris from surgical instruments, bac- terial endotoxins, meibomian gland secretions, powder from surgical gloves, marking pens, surgical drapes, iatrogenic epithelial defects, and femtosecond laser energy. 8–14 In this large retrospective, noncomparative case series, Lecci- sotti and Fields evaluated the incidence, clinical course, and prognosis of DLK in patients under- going low-energy femtosecond LASIK in combi- nation with sterile techniques to limit interface contamination. Our review will summarize the study's results, highlight its contributions to the literature of DLK in low-energy femtosecond LASIK, and discuss its limitations. Design and methods This study reviewed LASIK data of 37,315 eyes from 19,602 patients treated by one surgeon at a practice in Italy from 2012–2019. Inclusion criteria involved patients between the ages of 20–60 years with best preoperative vision >20/32 and cycloplegic spherical equivalents between –10.0 and +6.5 D. Exclusion crite- ria included any systemic collagen disease, diabetes, previous ocular disease or surgeries affecting central vision, and topical intraocular pressure treatment. Patients underwent pre- operative evaluation including comprehensive eye examination with manifest and cycloplegic refraction, pachymetry, Placido topography, Scheimpflug tomography, and anterior segment optical coherence tomography (AS-OCT). The surgeon used the low-energy LDV femtosecond laser (Ziemer) for LASIK flap creation in combi- nation with techniques to control interface The ASCRS Journal Club is a virtual, compli- mentary CME offering exclusive to ASCRS members that brings the experience of a lively discussion of two current articles from the Journal of Cataract & Refractive Surgery to the viewer. Co-moderated by Nick Mamalis, MD, and Leela Raju, MD, the February session featured a presentation by Haripriya Aravind, MS, lead author of "Com- parison of surgical repositioning rates and outcomes for hydrophilic vs. hydrophobic single piece acrylic toric IOLs." The second manuscript, "Diffuse lamellar keratitis after LASIK with low-energy femtosecond laser," was presented by Nhon Le, MD, resident, Cullen Eye Institute, Baylor College of Medicine. To view the February Journal Club session, visit: https://ascrs.org/clinical-edu- cation/journal-club/schedule/february-2021. Mitchell Weikert, MD Residency Program Director Cullen Eye Institute Baylor College of Medicine Houston, Texas Nhon Le, MD Resident Cullen Eye Institute Baylor College of Medicine Houston, Texas

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