Diffuse lamellar keratitis (DLK) is a sterileinflammation of the cornea which may occur after refractive surgery, such as LASIK. Its incidence has been estimated to be 1 in 500 patients,[1] though this may be as high as 32% in some cases.[2]
Patients typically present within one week of surgery with eye pain, photophobia, conjunctivitis, or excessive tear production.
Risk factorsedit
DLK is predominantly associated with Lasik, as the creation of a flap creates a potential space for cells to accumulate. Individuals with atopic conditions with pre-existing allergic conjunctivitis, or ocular rosacea, are more prone to developing the condition after surgery. Some authors have reported that moderate to severe eye allergies and chronic allergic conjunctivitis are an absolute contraindication to the LASIK procedure.[3] This is in distinction to findings of earlier studies.[4] Keratitis can also occur after photorefractive keratectomy (PRK), although because it occurs in the setting of infection, it is distinct from the sterile infiltrates of DLK.[5] DLK can also occur following myopic keratomileusis, in which a disc of corneal tissue is removed, shaped and sutured back into place, although this technique is more historical, having been replaced by Lasik and PRK.[6]
Pathologyedit
DLK is usually seen after refractive surgery. Neutrophils infiltrate the corneal stroma in a diffuse, multifocal pattern. Infiltration is confined to the surgical flap interface with no posterior or anterior extension, and overlying epithelium most often remains intact. As it is a sterile process, cultures based on swab tests are negative.
Diagnosisedit
Stagesedit
There are 4 stages of disease, with stage 4 being the rarest and most severe.
Stage 1 Cells infiltrate the periphery of the flap, without involving central cornea.
Stage 2 Peripheral cells migrate to the center of the cornea, and impair vision; presentation is usually 2 to 3 days after surgery.
Stage 3 Cells at the central cornea form clumps of dense cell aggregates.
Stage 4 Otherwise known as central toxic keratopathy, stage 4 characteristically has no inflammatory cells at the anterior chamber or cornea, but there is central stromal necrosis, and the cornea becomes opacified; onset is usually 3 to 9 days after refractive surgery.[7]
Treatmentedit
Depending on severity, therapies may range from topical or oral anti-inflammatories to irrigation and surgical repair.
^Bielory, B. P.; o’Brien, T. P. (2011). "Allergic complications with laser-assisted in-situ keratomileusis". Current Opinion in Allergy and Clinical Immunology. 11 (5): 483–491. doi:10.1097/ACI.0b013e32834a4e01. PMID 21822133. S2CID 7017248.
^Asano-Kato, N.; Toda, I.; Hori-Komai, Y.; Tsubota, K. (2001). "Allergic conjunctivitis as a risk factor for laser in situ keratomileusis". Journal of Cataract and Refractive Surgery. 27 (9): 1469–1472. doi:10.1016/S0886-3350(01)00909-9. PMID 11566533. S2CID 26826008.
^Faramarzi, A.; Feizi, S.; Javadi, M. A.; Rezaei Kanavi, M.; Yazdizadeh, F.; Moein, H. R. (2012). "Bilateral nocardia keratitis after photorefractive keratectomy". Journal of Ophthalmic & Vision Research. 7 (2): 162–166. PMC3520474. PMID 23275825.
^Smith, R.; Maloney, R. K. (1998). "Diffuse lamellar keratitis a new syndrome in lamellar refractive surgery". Ophthalmology. 105 (9): 1721–1726. doi:10.1016/S0161-6420(98)99044-3. PMID 9754183.
^Morgan, L. A. (2012). "Central toxic keratopathy: A case study and literature review". Optometry (St. Louis, Mo.). 83 (2): 74–79. PMID 23231367.
External linksedit
April 13, 2024
diffuse, lamellar, keratitis, sterile, inflammation, cornea, which, occur, after, refractive, surgery, such, lasik, incidence, been, estimated, patients, though, this, high, some, cases, specialtyophthalmology, contents, signs, symptoms, risk, factors, patholo. Diffuse lamellar keratitis DLK is a sterile inflammation of the cornea which may occur after refractive surgery such as LASIK Its incidence has been estimated to be 1 in 500 patients 1 though this may be as high as 32 in some cases 2 Diffuse lamellar keratitisSpecialtyOphthalmology Contents 1 Signs and symptoms 2 Risk factors 3 Pathology 4 Diagnosis 4 1 Stages 5 Treatment 6 References 7 External linksSigns and symptoms editPatients typically present within one week of surgery with eye pain photophobia conjunctivitis or excessive tear production Risk factors editDLK is predominantly associated with Lasik as the creation of a flap creates a potential space for cells to accumulate Individuals with atopic conditions with pre existing allergic conjunctivitis or ocular rosacea are more prone to developing the condition after surgery Some authors have reported that moderate to severe eye allergies and chronic allergic conjunctivitis are an absolute contraindication to the LASIK procedure 3 This is in distinction to findings of earlier studies 4 Keratitis can also occur after photorefractive keratectomy PRK although because it occurs in the setting of infection it is distinct from the sterile infiltrates of DLK 5 DLK can also occur following myopic keratomileusis in which a disc of corneal tissue is removed shaped and sutured back into place although this technique is more historical having been replaced by Lasik and PRK 6 Pathology editDLK is usually seen after refractive surgery Neutrophils infiltrate the corneal stroma in a diffuse multifocal pattern Infiltration is confined to the surgical flap interface with no posterior or anterior extension and overlying epithelium most often remains intact As it is a sterile process cultures based on swab tests are negative Diagnosis editStages edit There are 4 stages of disease with stage 4 being the rarest and most severe Stage 1 Cells infiltrate the periphery of the flap without involving central cornea Stage 2 Peripheral cells migrate to the center of the cornea and impair vision presentation is usually 2 to 3 days after surgery Stage 3 Cells at the central cornea form clumps of dense cell aggregates Stage 4 Otherwise known as central toxic keratopathy stage 4 characteristically has no inflammatory cells at the anterior chamber or cornea but there is central stromal necrosis and the cornea becomes opacified onset is usually 3 to 9 days after refractive surgery 7 Treatment editDepending on severity therapies may range from topical or oral anti inflammatories to irrigation and surgical repair References edit Diffuse Lamellar Keratitis DLK Refractivesource com Retrieved 2013 01 10 DLK Diffuse Lamellar Keratitis LASIK Complications Retrieved 2013 01 10 Bielory B P o Brien T P 2011 Allergic complications with laser assisted in situ keratomileusis Current Opinion in Allergy and Clinical Immunology 11 5 483 491 doi 10 1097 ACI 0b013e32834a4e01 PMID 21822133 S2CID 7017248 Asano Kato N Toda I Hori Komai Y Tsubota K 2001 Allergic conjunctivitis as a risk factor for laser in situ keratomileusis Journal of Cataract and Refractive Surgery 27 9 1469 1472 doi 10 1016 S0886 3350 01 00909 9 PMID 11566533 S2CID 26826008 Faramarzi A Feizi S Javadi M A Rezaei Kanavi M Yazdizadeh F Moein H R 2012 Bilateral nocardia keratitis after photorefractive keratectomy Journal of Ophthalmic amp Vision Research 7 2 162 166 PMC 3520474 PMID 23275825 Smith R Maloney R K 1998 Diffuse lamellar keratitis a new syndrome in lamellar refractive surgery Ophthalmology 105 9 1721 1726 doi 10 1016 S0161 6420 98 99044 3 PMID 9754183 Morgan L A 2012 Central toxic keratopathy A case study and literature review Optometry St Louis Mo 83 2 74 79 PMID 23231367 External links edit Retrieved from https en wikipedia org w index php title Diffuse lamellar keratitis amp oldid 1132102472, wikipedia, wiki, book, books, library,
