DLK after LASIK

• inflammatory cells (eosinophils, neutrophils, lymphocytes) that migrated underneath the LASIK flap
• leads to collagenolytic activity that weakens the corneal structure and leads to stromal melting and ectasia
• 0.2%-5.3% incidence
• occurs in both mechanical microkeratome and IntraLase procedures
• usually due to bacterial endotoxins released from sterilizer reservoirs
• can occur as soon as 24 hours after surgery or as a late-onset problem, occuring many months after surgery
• increased risk: epithelial defects after surgery or patients who have atopic disease

Signs/symptoms:

• symptoms may mimic dry eye
• grainy appearance b/w the flap and underlying stromal bed
• only mildly hyperemic conjunctiva
• no ciliary flush like infectious keratitis
• as severity increases, may cause decrease in VA, irregular astigmatism, ectasia, hyperopia

Treatment:

• Pred Forte q1-2hour, follow-up every day until improves
• topical fluoroquinolone tid prophylaxis if needed
• cyclopentolate for pain
• severe cases need referral back to surgeon to lift flap and irrigate the area with sterile balanced salt solution to remove inflammatory cells
• severe cases oral prednisolone 40-80mg per day for at least one week