RESUMEN
PURPOSE: To examine the evidence that a series of cases of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) was caused by a type of marker pen. SETTING: Eye Institute, Auckland, New Zealand. METHODS: During a 10-week period, 522 consecutive LASIK procedures were performed using a 60 Hz IntraLase femtosecond laser (IntraLase Corp.) to create the LASIK flap and a 217Z 100 Hz excimer laser (Bausch & Lomb) to perform the refractive ablation. As standard practice, a marking pen was used to enable accurate flap realignment. Three weeks after a sudden increase in the incidence of DLK was identified, one of the 5 surgeons performed 5 consecutive bilateral cases using the marking pen in the right eyes but not in the left eyes. RESULTS: Of the 522 LASIK cases (119 without marking pen, 403 with marking pen), DLK developed in 49 (9.4%). No eye treated without the marking pen developed DLK; of those in which the marking pen was used, 49 (12.2%) developed DLK (P<0.0001, Fischer exact test; odds ratio, 27). In the 5 consecutive bilateral cases in which the marking pen was used in the right eye but not the left eye, 4 right eyes and no left eye developed DLK (P=0.03). Forty-five of the 49 eyes with DLK quickly recovered. The other 4 developed central toxic keratopathy. CONCLUSION: There is strong statistical evidence that the marking pen was a factor in the occurrence of DLK.
Asunto(s)
Brotes de Enfermedades , Tinta , Queratitis/inducido químicamente , Queratitis/epidemiología , Queratomileusis por Láser In Situ/instrumentación , Complicaciones Posoperatorias , Equipo Quirúrgico/efectos adversos , Humanos , Láseres de Excímeros/uso terapéutico , Miopía/cirugía , Nueva Zelanda/epidemiología , Oportunidad Relativa , Estudios Prospectivos , Factores de Riesgo , Colgajos Quirúrgicos , Agudeza VisualRESUMEN
Over a period of approximately 7 months, multiple subepithelial spots were noted in one or both corneas of some patients examined 2 to 6 months after laser in situ keratomileusis (LASIK). The lesions appeared identical to adenovirus keratitis. The eyes were quiet, had good vision, and no patient had a history of adenoviral keratoconjunctivitis. In all eyes, the lesions resolved spontaneously or with topical steroid eyedrops. All investigations were negative for adenovirus. Corneal laser scanning in vivo confocal microscopy revealed Langerhans cells in the epithelium, which disappeared after the lesions resolved.