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104. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft 2006
Abstract
Abstract
FR.06.09 Diffuse lamellar keratitis after laser-in-situ-keratomileusis: A confocal microscopic examination Cichocki M.1, Bühren J.1,2, Kohnen T.1
1Klinik für Augenheilkunde der Johann Wolfgang Goethe-Universität Frankfurt am Main; 2Department of Ophthalmology, University of Rochester Medical Center, Rochester, USA Objective: Laser-in-situ-keratomileusis (LASIK) has become the most popular refractive surgical procedures worldwide. One of the complications after LASIK is diffuse lamellar keratitis (DLK), which is a sterile inflammation containing granulocytes and usually occurs between the first and the 10th day after surgery, although it also may occur much later. Thus, in some cases DLK can be severe and may end in visual loss. Further in-vivo evaluation of the living human cornea by confocal microscopy (CM) may give important information.
Methods: 65 eyes of 35 patients have been examined additionally to the clinical slitlamp (SL) examination by confocal microscopy 1 day, 7 days and 1 month after LASIK. The cornea was divided into 5 segments, one central and 4 at the periphery.
Results: In 183 (20%) of 925 segments CM showed a sterile inflammation. Most inflammatory cells were diagnosed after one day (52 eyes, 80%), many after seven days (32 eyes, 49%) and least after one month (7 eyes, 11%). Mainly, these infiltrates included less than 1000 cells per mm2. The topographic distribution showed most infiltrates at the periphery, especially in the superior and in the nasal segment. Spindle-shaped formations that occurred after LASIK correlated directly with the infiltrates. Activated keratocytes, needle like structures, debris, folds and pinpoint epithelial defects showed no significant correlation with the inflammation (p>.05). CM showed that sterile infiltrates appeared more often than DLK could be actually diagnosed in SL examination. Especially, infiltrates in the superior and the nasal segments were not diagnosed under the SL.
Conclusions: This study showed that an infiltrate in CM with less than 1000 cells per mm2 represents mainly a regular reaction after LASIK. Because of the low density of these infiltrates they might often be overlooked. Thus, this occurrence could be well described as DLK 0° and might be connected with appropriate wound healing processes. However, CM also showed that higher density infiltrates were not clinically revealed. Therefore, the routine examination should include a proper view at the superior and nasal part of the LASIK flap area.
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