Five-Year Incidence, Management, and Visual Outcomes of Diffuse Lamellar Keratitis after Femtosecond-Assisted LASIK

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Abstract

Femtosecond (FS) lasers initially had a higher incidence of diffuse lamellar keratitis (DLK) compared with microkeratome flap creation. It has been theorized that higher-frequency lower-energy (HFLE) FS lasers would reduce the incidence of DLK. Our study sought to evaluate the incidence of newer HFLE FS lasers with pulse frequencies above 60 kHz. It was a retrospective case-control study evaluating the incidence of DLK following flap creation with one of three FS lasers (AMO iFs, WaveLight FS200, Zeiss VisuMax). Uncomplicated LASIK cases were included as the control group (14,348 eyes) and cases of DLK were recorded in the study group (637 eyes). Of the 637 cases of DLK, 76 developed stage II, 25 progressed to stage III, and only three developed stage IV DLK. The overall incidence rate of DLK was 4.3%; it has fallen with the invention of newer HFLE FS lasers and is approaching the DLK incidence rates of DLK with microkeratome.

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Most cited references 32

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Laser in situ keratomileusis flap complications using mechanical microkeratome versus femtosecond laser: retrospective comparison.

Vahid Feiz, Majid Moshirfar, Mark Mifflin … (2010)

To compare the incidence of flap complications after creation of laser in situ keratomileusis (LASIK) flaps using a zero-compression microkeratome or a femtosecond laser. John A. Moran Eye Center, Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA. Evidence-based manuscript. The flap complication rate was evaluated during the initial 18 months of experience using a zero-compression microkeratome (Hansatome) or a femtosecond laser (IntraLase FS60) for flap creation. The flap complication rate was 14.2% in the microkeratome group and 15.2% in the femtosecond laser group (P = .5437). The intraoperative flap complication rate was 5.3% and 2.9%, respectively (P = .0111), and the postoperative flap complication rate, 8.9% and 12.3%, respectively (P = .0201). The most common intraoperative complication in the microkeratome group was major epithelial defect/sloughing; the rate (2.6%) was statistically significantly higher than in the femtosecond laser group (P = .0006). The most common postoperative complication in both groups was diffuse lamellar keratitis (DLK) (6.0%, microkeratome; 10.6%, femtosecond laser) (P = .0002). Although the total complication rates between the 2 groups were similar, the microkeratome group had significantly more epithelial defects intraoperatively and the femtosecond laser group had significantly more DLK cases postoperatively. Copyright © 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

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Femtosecond laser and microkeratome corneal flaps: comparison of stromal wound healing and inflammation.

Mary Rayborn, Chikako Suto, William J Dupps … (2007)

To examine early postoperative wound healing in rabbit corneas that had LASIK flaps formed with three different models (15 KHz, 30 KhZ, and 60 KHz) of a femtosecond laser compared with flaps formed with a microkeratome. Thirty-nine rabbit eyes were randomized to receive either no surgery or corneal flaps formed with one of the lasers or the microkeratome. Sixteen eyes also had lamellar cuts with no side cuts with the 30 KHz laser. Animals were sacrificed and corneas processed as frozen sections or fixed for transmission electron microscopy. Frozen sections were evaluated with the TUNEL assay to detect apoptosis, immunocytochemistry for Ki67 to detect cell mitosis, and immunocytochemistry for CD11b to detect mononuclear cells. Rabbit corneas that had flaps formed with the 15 KHz laser had significantly more stromal cell death, greater stromal cell proliferation, and greater monocyte influx in the central and peripheral comea at 24 hours after surgery than corneas that had flaps formed with the 30 KHz or 60 KHz laser or the microkeratome. Results of the 60 KHz laser and microkeratome were not significantly different for any of the parameters at 24 hours, except for mitotic stromal cells at the flap margin. Transmission electron microscopy revealed that the primary mode of stromal cell death at 24 hours after laser ablation was necrosis. Stromal cell necrosis associated with femtosecond laser flap formation likely contributes to greater inflammation after LASIK performed with the femtosecond laser, especially with higher energy levels that result in greater keratocyte cell death.

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Flap dimensions created with the IntraLase FS laser.

KATHERINE S. BINDER (2003)

To assess the safety and predictability of the IntraLase femtosecond laser to create accurate flap thickness and diameter. Clinical office-based practice. In the first 103 eyes in which flaps were created with the IntraLase laser, the flap thickness was measured by the ultrasonic difference between the preoperative and post-flap-creation central corneal thickness and the flap diameter was measured with calipers. As the attempted flap thickness decreased from 140.0 microm to 110.0 microm in 10.0 microm increments, the mean flap thickness decreased from 132.5 microm to 125.0 microm, with standard deviations decreasing from +/-18.5 to +/-12.0 microm. The mean flap diameter differed from the attempted diameter by less than 0.03 microm in all but the 130.0 microm group. Two slipped flaps and 20 cases of interface inflammation occurred early in the series. The IntraLase laser, while adding technical complexity to the laser in situ keratomileusis procedure, is able to predictably create flap diameters, hinge location, and flap thickness while eliminating the risk for cap perforations. The technique of flap elevation affects rapidity of visual recovery.

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Author and article information

Contributors

Francisco Javier Ascaso: Role: Academic Editor

Journal

Journal ID (nlm-ta): J Clin Med

Journal ID (iso-abbrev): J Clin Med

Journal ID (publisher-id): jcm

Title: Journal of Clinical Medicine

Publisher: MDPI

ISSN (Electronic): 2077-0383

Publication date (Electronic): 11 July 2021

Publication date Collection: July 2021

Volume: 10

Issue: 14

Electronic Location Identifier: 3067

Affiliations

[1 ]Hoopes Vision, HDR Research Center, 11820 S. State Street Suite #200, Draper, UT 84020, USA; kms04@ 123456gmail.com (K.M.S.); smccabe@ 123456hoopesvision.com (S.E.M.); yronquillo@ 123456hoopesvision.com (Y.C.R.); pch@ 123456hoopesvision.com (P.C.H.)

[2 ]John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, Salt Lake City, UT 84132, USA

[3 ]Utah Lions Eye Bank, Murray, UT 84107, USA

[4 ]School of Medicine, University of Utah, Salt Lake City, UT 84132, USA; kathryn.durnford@ 123456hsc.utah.edu (K.M.D.); William.West@ 123456hsc.utah.edu (W.B.W.J.)

[5 ]College of Osteopathic Medicine, Kansas City University, Kansas City, MO 64106, USA; adamlewis@ 123456kansascity.edu

[6 ]McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA; chase.m.miller@ 123456uth.tmc.edu (C.M.M.); macgregor.hall@ 123456uth.tmc.edu (M.N.H.)

[7 ]Brigham Young University, Provo, UT 84602, USA; gillison.west1@ 123456gmail.com (D.G.W.); rasperry@ 123456byu.edu (R.A.S.)

[8 ]Department of Ophthalmology, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL 32209, USA

[9 ]Mission Hills Eye Center, Pleasant Hill, CA 94523, USA

Author notes

[* ]Correspondence: cornea2020@ 123456me.com ; Tel.: +1-801-568-0200; Fax: +1-801-563-0200

Author information

Majid Moshirfar https://orcid.org/0000-0003-1024-6250

Kathryn M Durnford https://orcid.org/0000-0002-5023-9496

Yasmyne C Ronquillo https://orcid.org/0000-0002-8852-4380

Article

Publisher ID: jcm-10-03067

DOI: 10.3390/jcm10143067

PMC ID: 8304683

PubMed ID: 34300233

SO-VID: 98f8b58a-0365-41d1-bf1d-8bb2b2b544a2

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

History

Date received : 08 June 2021

Date accepted : 01 July 2021

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Five-Year Incidence, Management, and Visual Outcomes of Diffuse Lamellar Keratitis after Femtosecond-Assisted LASIK

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Most cited references 32

Laser in situ keratomileusis flap complications using mechanical microkeratome versus femtosecond laser: retrospective comparison.

Femtosecond laser and microkeratome corneal flaps: comparison of stromal wound healing and inflammation.

Flap dimensions created with the IntraLase FS laser.

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