Bilateral Marginal Sterile Infiltrates and Diffuse Lamellar Keratitis After Laser in situ Keratomileusis

Journal of Refractive Surgery - Tập 19 Số 2 - Trang 154-158 - 2003
Renato Ambrósio1, Laura M. Periman, Marcelo V. Netto, Steven E. Wilson
1Department of Ophthalmology, University of Washington, Seattle, WA 98195, USA

Tóm tắt

ABSTRACT PURPOSE: To report cases of acute bilateral catarrhal infiltrates in the early postoperative period after laser in situ keratomileusis (LASIK). METHODS: Retrospective review of both eyes of two patients. RESULTS: Two patients developed acute bilateral, marginal, catarrhal infiltrates in the early postoperative period after LASIK. Both patients had moderate to severe chronic meibomian gland dysfunction preoperatively. One patient (both eyes) developed grade 3 diffuse lamellar keratitis (DLK) that required both flaps to be lifted for irrigation and cleaning on postoperative day 5. Fungal and bacterial cultures were negative in both eyes of both patients. The condition resolved with intensive topical corticosteroids and fortified antibiotics. Regression of refractive error and the need for enhancement was encountered in all eyes. There was mild recurrence in one eye of each patient with pretreatment with topical corticosteroids prior to enhancement. CONCLUSIONS: Endogenous factors such as chronic blepharitis and meibomian gland dysfunction may trigger inflammation resulting in sporadic cases of catarrhal infiltrates after LASIK. These patients may have chronic inflammatory milieus that can trigger sporadic cases of catarrhal infiltrates after LASIK, with accompanying diffuse lamellar keratitis. (J Refract Surg 2003;19:154-158)

Từ khóa


Tài liệu tham khảo

1. Ambrosio R. Jr Wilson SE. LASIK complications: etiology prevention and treatment. J Refract Surg 2001;17:350-379.

2. Wilson SE. LASIK: Management of common complications. Cornea 1998;17:459-467.

3. Lindstrom RL. Hardten DR. Chu YR. Laser in situ keratomileusis (LASIK) for the treatment of low moderate and high myopia. Trans Am Ophthalmol Soc 1997;95:285-296.

4. Farah SG Azar DT Gurdal C Wong J. Laser in situ keratomileusis: literature review of a developing technique. J Cataract Refract Surg 1998;24:989-1006.

5. Stulting RD Carr JD. Thompson KP. Waring GO III Wiley WM. Walker JG. Complications of laser in situ keratomileusis for the correction of myopia. Ophthalmology 1999;106:13-20.

6. Wilson SE. Laser in situ keratomileusis-induced (presumed) neurotrophic epitheliopathy. Ophthalmology 2001:108: 1082-1087.

7. Wilson SE Ambrosio R. Laser in situ keratomileusisinduced neurotrophic epitheliopathy. Am J Ophthalmol 2001;132:405-406.

8. Linebarger EJ. Hardten DR. Lindstrom RL. Diffuse lamellar keratitis: diagnosis and management. J Cataract Refract Surg 2000;26:1072-1077.

9. Robin JB Dugel R Robin SB. Immunologic disorders of the cornea and conjunctiva. In: Kaufman HB Barron BA McDonald MB eds. The Cornea. Second Edition on CDRom. Newton. MA: Butterworth-Heinemann: 1999.

10. Mondino BJ Cruz TA Kowalski RR Immune responses in rabbits with phlyctenules and catarrhal infiltrates. Arch Ophthalmol 1983;101:1275-1277.

11. Mondino BJ Adamu SA Pitchekian-Halabi H. Antibody studies in a rabbit model of corneal phlyctenulosis and catarrhal infiltrates related to Stapbylococcus aureus. Invest Ophthalmol Vis Sci 1991;32:1854-1863.

12. Wilson SE Mohan RR Hong JW Lee JS Choi R Mohan RR. The wound healing response after laser in situ keratomileusis and photorefractive keratectomy: elusive control of biological variability and effect on custom laser vision correction. Arch Ophthalmol 2001;119:889-896.

13. Wilson SE Mohan RR Mohan RR Ambrosio Jr R Hong J-W Lee J-S. The corneal wound healing response: Cytokine-mediated interaction of the epithelium stroma and inflammatory cells. Prog Ret Eve Res 2001;20:625-637.

14. Wilson SE Schultz GS Chegini N Weng J He Y-G. Epidermal growth factor transforming growth factor alpha transforming growth factor beta acidic fibroblast growth factor basic fibroblast growth factor and interleukin-1 proteins in the cornea. Exp Eye Res 1994;59:63-72.

15. Hong W-J Liu JJ Lee J-S Mohan RR Mohan RR Woods D. He Y-G Wilson SE. Proinflammatory chemokine induction in keratocytes and inflammatory cell infiltration into the cornea. Invest Ophthalmol Vis Sci 2001;42:2795-2803.

16. Haw WW Manche EE. Sterile peripheral keratitis following laser in situ keratomileusis. J Refract Surg 1999;15:61-63.

17. Aras C Ozdamar A. Bahcecioglu H. Sener B. Corneal interface abscess after excimer laser in situ keratomileusis. J Refract Surg 1998;14:156-157.

18. Lam DS Leung AT. Wu JT Fan DS Cheng AC Wang Z. Culture-negative ulcerative keratitis after laser in situ keratomileusis. J Cataract Refract Surg 1999;25:1004-1008.

19. MacRae S Macaluso DC Rich LF. Sterile interface keratitis associated with micropannus hemorrhage after laser in situ keratomileusis. J Cataract Refract Surg 1999;25:1679-1681.

20. Macaluso DC Rich LF MacRae S. Sterile interface keratitis after laser in situ keratomileusis: three episodes in one patient with concomitant contact dermatitis of the evelids. J Refract Surg 1999;15:679-682.

21. Johnson JD. Harissi-Dagher M. Pineda R Yoo S Azar DT Diffuse lamellar keratitis: Incidence associations outcomes and a new classification system. J Cataract Refract Surg 2001;27:1560-1566.

22. Wilson SE Ambrosio Jr R. Sporadic diffuse lamellar keratitis (DLK) following LASIK: Contrast with epidemic (exogenous) DLK. Cornea 2002;21:560-563.

23. Holland EJ Schwartz GS. Classification of herpes simplex virus keratitis. Cornea 1999;18:144-154.

24. Pepose JS Laycock KA Miller JK Chansue E Lenze EJ Gans LA Smith ME. Reactivation of latent herpes simplex virus by excimer laser photokeratectomy. Am J Ophthalmol 1992; 114:45-50.

25. Dhaliwal DK Barnhorst DA Jr Romanowski E Rehkopf PG Gordon YJ. Efficient reactivation of latent herpes simplex virus type 1 infection by excimer laser keratectomy in the experimental rabbit ocular model. Am J Ophthalmol 1998;125:488-492.