Eyeworld

MARCH 2021 | EYEWORLD | 21 regimen described above, the patient recovered to a CDVA of 20/40 with a hyperopic shift in the right eye and a UDVA of 20/20 in the left eye. Patient 3 was initially thought to have bilateral bacterial conjunctivitis but was later diagnosed with bilateral grade 4 DLK. Given the concern for possible bacterial conjunctivitis, flap lifting and irrigation were not performed. This patient was treated with netilmicin 0.3% and dexamethasone 0.1% four times daily for 5 days (followed by a taper over 2 weeks). At 12 months postoperatively, the CDVA was 20/25 and 20/32 with a hyperopic shift in both eyes. In all cases of grade 4 DLK, stromal thin- ning and reabsorption was seen at 1 month, followed by partial recovery from 3 months to 2 years. OCT measurements of central corneal ep- ithelial thickness, which were available in three eyes (patient 2 and 3), showed a significant compensatory increase at 12 months. However, no patients made a full-thickness recovery. in patients who underwent bilateral LASIK. The mean age of patients diagnosed with grade 2–4 DLK was 47 years, 9.48 years greater than the mean age of eyes without DLK. DLK outbreaks were not observed. Clinical course Grade 1 and 2 DLK: All patients with grade 1 and 2 DLK fully recovered and retained uncor- rected distance visual acuity (UDVA) >20/20 af- ter treatment with dexamethasone 0.1% topical solution every 2 hours while awake for 5 days. Grade 3 and 4 DLK: Patient 1 had bilateral grade 3 DLK that progressed to bilateral grade 4 DLK despite flap lifting and irrigation. At 2 years postoperatively, the corrected distance visual acuity (CDVA) was 20/20 and 20/25 with a hyperopic shift in both eyes. The patient under- went repeat femtosecond LASIK with creation of a new flap in the left eye without complications and had a CDVA of 20/25 (–0.25 x 95). Patient 2 had grade 4 DLK in the right eye and grade 3 in the left eye but did not under- go flap lifting and irrigation due to a delayed presentation. After treatment with the steroid continued on page 22 Cullen Eye Institute residents; top, from left: Rohini Sigireddi, MD, Nhon Le, MD; bottom: Margaret Wang, MD Source: Cullen Eye Institute References 1. Stulting RD, et al. The epidemi- ology of diffuse lamellar keratitis. Cornea. 2004;23:680–688. 2. McLeod SD, et al. Bilateral diffuse lamellar keratitis following bilateral simultaneous versus sequential laser in situ keratomileusis. Br J Ophthalmol. 2003;87:1086–1087. 3. Gil-Cazorla R, et al. Incidence of diffuse lamellar keratitis after laser in situ keratomileusis asso- ciated with the IntraLase 15 kHz femtosecond laser and Moria M2 microkeratome. J Cataract Refract Surg. 2008;34:28–31. 4. Johnson JD, et al. Diffuse lamellar keratitis: incidence, as- sociations, outcomes, and a new classification system. J Cataract Refract Surg. 2001;27:1560–1566. 5. Haft P, et al. Complications of LASIK flaps made by the IntraLase 15- and 30-kHz fem- tosecond lasers. J Refract Surg. 2009;25:979–984. 6. Javaloy J, et al. Confocal microscopy comparison of IntraLase femtosecond laser and Moria M2 microkeratome in LASIK. J Refract Surg. 2007;23:178–187. 7. Tomita M, et al. Comparison of DLK incidence after laser in situ keratomileusis associated with two femtosecond lasers: Femto LDV and IntraLase FS60. Clin Ophthalmol. 2013;7:1365–1371. 8. Moyer PD, et al. Interface ker- atitis after LASIK may be caused by microkeratome lubricant deposits. Invest Ophthalmol Vis Sci. ARVO abstract 3454. 9. Holland SP, et al. Diffuse lamellar keratitis related to en- dotoxins released from sterilizer reservoir biofilms. Ophthalmolo- gy. 2007;107:1227–1233.

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