LASIK Complications 2001-DLK Dr. Jeff Machat

3 Primary Post-operative Complications:

Diffuse Lamellar Keratitis Epithelial Ingrowth Corneal Striae 3 Primary Post-operative Complications

Diffuse Lamellar Keratitis:

Diffuse Lamellar Keratitis DLK is a sterile inflammatory reaction which develops within the interface within 48hrs post-LASIK Also known as Sands of the Sahara because of the “ sifted sands ” clinical appearance Interface haze actually WBCs and may be reaction to bacterial protein

Diffuse Lamellar Keratitis:

Diffuse Lamellar Keratitis White quiet comfortable eyes unlike true LASIK infections Can be in one or both eyes Can follow primary or secondary LASIK Usually mild but can become severe affecting vision and refractive error

Diffuse Lamellar Keratitis:

Diffuse Lamellar Keratitis Machat DLK Grading System Grade 1 DLK: (1% of LASIK) Trace PRK haze at level of interface not affecting vision or refractive error Typically sectoral but becomes diffuse, often confused with SPK Very steroid sensitive, treat with Predforte Q1H tapered over 3 weeks

DLK Grade 2:

DLK Grade 2

Diffuse Lamellar Keratitis:

Diffuse Lamellar Keratitis Grade 2 DLK (0.2% overall) progresses from grade 1 if untreated Interface infiltrate more central with melting resulting in hyperopic refractive shift and 1-2 lines loss of bcva Hourly Predforte with interface cleaning within 1-7 days if not better

Grade 2 Diffuse Lamellar Keratitis:

Grade 2 Diffuse Lamellar Keratitis

Diffuse Lamellar Keratitis:

Diffuse Lamellar Keratitis Grade 3 DLK occurs rarely (<0.02%), if Grade 2 DLK treated late or inadequately Dense central interface infiltrate like Grade 3 PRK haze Central striae common as stromal melting evident and significant hyperopic shift with loss of bcva

Diffuse Lamellar Keratitis:

Diffuse Lamellar Keratitis Treatment for Grade 3 DLK is surgical followed by topical steroids Corneal flap is lifted and infiltrate wiped, then hyperopic ablation. PTK and irrigation also used to clean interface. Retreatment often needed at 1-4 months

DLK Grade 3 Central striae:

DLK Grade 3 Central striae

DLK Grade 3 Dense Infiltrate:

DLK Grade 3 Dense Infiltrate

DLK Grade 3 post-treatment:

DLK Grade 3 post-treatment

DLK Grade 3 after 1 week:

DLK Grade 3 after 1 week

DLK Grade 3 after 3 weeks:

DLK Grade 3 after 3 weeks

DLK Cleared at 3 months:

DLK Cleared at 3 months

Slide 16:

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T HANK Y OU Dr. Jeffery J. Machat 2001 Property of Dr. Jeffery J. Machat. All rights reserved. Unauthorized use is prohibited.