Diffuse lamellar keratitis

Last updated
Diffuse lamellar keratitis
Specialty Ophthalmology

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]

Contents

Signs and symptoms

Patients typically present within one week of surgery with eye pain, photophobia, conjunctivitis, or excessive tear production.

Risk factors

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of corneal tissue is removed, shaped and sutured back into place, although this technique is more historical, having been replaced by Lasik and PRK.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]

Pathology

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.

Diagnosis

Stages

There are 4 stages of disease, with stage 4 being the rarest and most severe.

Treatment

Depending on severity, therapies may range from topical or oral anti-inflammatories to irrigation and surgical repair.

Related Research Articles

Far-sightedness Eye condition in which light is focused behind instead of on the retina

Far-sightedness, also known as long-sightedness, hypermetropia, or hyperopia, is a condition of the eye where distant objects are seen clearly but near objects appear blurred. This blurred effect is due to incoming light being focused behind, instead of on, the retina wall due to insufficient accommodation by the lens. Small amount of hypermetropia in young patients is usually corrected by their accommodation, without any defects in vision. But, due to this accommodative effort for distant vision, people may complain asthenopic symptoms while constant reading. Some hypermetropes can see clear at distance, but near vision may be blurred due to insufficient accommodation. For this reason, this defect is referred as far-sightedness. If the hypermetropia is high, there will be defective vision for both distance and near. People may also experience accommodative dysfunction, binocular dysfunction, amblyopia, and strabismus. Newborns are almost invariably hypermetropic, it will gradually decrease as the age increase.

LASIK Corrective opthalmological surgery

LASIK or Lasik, commonly referred to as laser eye surgery or laser vision correction, is a type of refractive surgery for the correction of myopia, hyperopia, and astigmatism. LASIK surgery is performed by an ophthalmologist who uses a laser or microkeratome to reshape the eye's cornea in order to improve visual acuity. For most people, LASIK provides a long-lasting alternative to eyeglasses or contact lenses.

Photorefractive keratectomy Eye surgery

Photorefractive keratectomy (PRK) and laser-assisted sub-epithelial keratectomy (LASEK) are laser eye surgery procedures intended to correct a person's vision, reducing dependency on glasses or contact lenses. LASEK and PRK permanently change the shape of the anterior central cornea using an excimer laser to ablate a small amount of tissue from the corneal stroma at the front of the eye, just under the corneal epithelium. The outer layer of the cornea is removed prior to the ablation.

Eye surgery

Eye surgery, also known as ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist. The eye is a very fragile organ, and requires extreme care before, during, and after a surgical procedure to minimise or prevent further damage. An expert eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. Today it continues to be a widely practiced type of surgery, with various techniques having been developed for treating eye problems.

Radial keratotomy Refractive surgical procedure to correct myopia (nearsightedness

Radial keratotomy (RK) is a refractive surgical procedure to correct myopia (nearsightedness) that was developed in 1974, by Svyatoslav Fyodorov, a Russian ophthalmologist. It has been largely supplanted by newer operations, such as photorefractive keratectomy, LASIK, Epi-LASIK and the phakic intraocular lens.

Keratomileusis, from Greek κέρας and σμίλευσις, or corneal reshaping, is the surgical improvement of the refractive state of the cornea by surgically reshaping it. It is the most common form of refractive surgery. The first usable technique was developed by José Ignacio Barraquer, commonly called "the father of modern refractive surgery."

Refractive surgery Medical specialty

Refractive eye surgery is non-essential eye surgery used to improve the refractive state of the eye and decrease or eliminate dependency on glasses or contact lenses. This can include various methods of surgical remodeling of the cornea (keratomileusis), lens implantation or lens replacement. The most common methods today use excimer lasers to reshape the curvature of the cornea. Successful refractive eye surgery can reduce or cure common vision disorders such as myopia, hyperopia, presbyopia and astigmatism.

Epi-LASIK is a refractive surgery technique designed to reduce a person's dependency on eyeglasses and contact lenses. Invented by Dr. Ioannis Pallikaris, the technique is basically an automatic LASEK without alcohol; it can be better considered as superficial LASIK. The stromal bed is smoother than that obtained by mechanical methods or brush. Unlike alcohol (LASEK), there is no chance of damaging the limbal stem cells. It is also relatively less painful than LASEK.

  1. A device similar to a microkeratome slides over the surface of the cornea, just underneath the epithelial layer of cells while suction is applied.
  2. The result is a hinged sheet of epithelium that is at least partially viable.
  3. It is reflected out of the way so that the ablation can take place.
  4. The sheet is repositioned and a bandage soft contact lens is placed on the eye.
Vernal keratoconjunctivitis

Vernal keratoconjunctivitis (VKC) is a recurrent, bilateral, and self-limiting inflammation of conjunctiva, having a periodic seasonal incidence.

Corneal epithelium

The corneal epithelium is made up of epithelial tissue and covers the front of the cornea. It acts as a barrier to protect the cornea, resisting the free flow of fluids from the tears, and prevents bacteria from entering the epithelium and corneal stroma.

Phototherapeutic keratectomy (PTK) is a type of eye surgery that uses a laser to treat various ocular disorders by removing tissue from the cornea. PTK allows the removal of superficial corneal opacities and surface irregularities. It is similar to photorefractive keratectomy, which is used for the treatment of refractive conditions. The common indications for PTK are corneal dystrophies, scars, opacities, and bullous keratopathy.

Band keratopathy

Band keratopathy is a corneal disease derived from the appearance of calcium on the central cornea. This is an example of metastatic calcification, which by definition, occurs in the presence of hypercalcemia.

Pellucid marginal degeneration

Pellucid marginal degeneration (PMD), is a degenerative corneal condition, often confused with keratoconus. It typically presents with painless vision loss affecting both eyes. Rarely, it may cause acute vision loss with severe pain due to perforation of the cornea. It is typically characterized by a clear, bilateral thinning (ectasia) in the inferior and peripheral region of the cornea, although some cases affect only one eye. The cause of the disease remains unclear.

Vision of humans and other organisms depends on several organs such as the lens of the eye, and any vision correcting devices, which use optics to focus the image.

Jeff Machat MD, FRCSC, DABO is an ophthalmologist in the United States and Canada specializing in surgical vision correction better known as refractive eye surgery.

Peter S. Hersh is an American ophthalmologist and specialist in LASIK eye surgery, keratoconus, and diseases of the cornea. He co-authored the article in the journal Ophthalmology that presented the results of the study that led to the first approval by the U.S. Food and Drug Administration (FDA) of the excimer laser for the correction of nearsightedness in the United States. Hersh was also medical monitor of the study that led to approval of corneal collagen crosslinking for the treatment of keratoconus.

Sheraz Daya is a British ophthalmologist. Daya founded the Centre for Sight in 1996, and works in stem-cell research and sight recovery surgery.

Emil William Chynn is a Chinese-American LASEK surgeon, author, researcher, and media personality. He owns the only laser vision correction center in the US specializing in Advanced Surface Ablation, which unlike LASIK is a newer, safer way to correct refractive errors that does not involve cutting a flap into the cornea. Dr. Chynn has been featured in the New York Times, Wall Street Journal, on CNN and Discovery Channel, in Time Magazine online, as well as on ABC, NBC, CBS, and Fox News for LASEK as well as platinum "Eye Jewelry" and corneal tattoos. Dr. Chynn has also appeared on the Howard Stern Show as one of NYC's most eligible bachelors, as well on "Millionaire Matchmaker" with abrasive reality TV matchmaker Patti Stanger.

Post-LASIK ectasia is a condition similar to keratoconus where the cornea starts to bulge forwards at a variable time after LASIK, PRK, or SMILE corneal laser eye surgery.

Exposure keratopathy is medical condition affecting the cornea of eyes. It can lead to corneal ulceration and permanent loss of vision due to corneal opacity.

References

  1. ↑ "Diffuse Lamellar Keratitis (DLK) –". Refractivesource.com. Retrieved 2013-01-10.
  2. ↑ "DLK - Diffuse Lamellar Keratitis". LASIK Complications. Retrieved 2013-01-10.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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. PMC   3520474 . PMID   23275825.
  6. ↑ 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.
  7. ↑ Morgan, L. A. (2012). "Central toxic keratopathy: A case study and literature review". Optometry (St. Louis, Mo.). 83 (2): 74–79. PMID   23231367.
Classification
D
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.