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M Miyake-Kashima, H Bissen-Miyajima, Y Taira, K Minami, M Nakamura; Stage I and II Diffuse Lamellar Keratitis: Its Occurrence and Time Course in Endotoxin-treated Rabbit Eyes . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2104.
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Purpose: To understand the pathophysiology and the course of diffuse lamellar keratitis (DLK) following laser in situ keratomileusis (LASIK), we investigated the appearance of mild DLK using endotoxin in rabbit eyes and chronologically observed the clinical score of DLK. Methods: Corneal flaps were created in 34 eyes of pigmented rabbits by using ACS microkeratome (automated corneal shaper; Bausch & Lomb). The bed of corneal flap was treated with 5 µl of Pseudomonas aeruginosa endotoxin with 4 concentrations (10pg, 1ng, 100ng, and 10µg/ml). These concentrations were determined from preliminary measurement of endotoxin level in sterilizer reservoir. The flaps were then repositioned and sutured. On 1,3,4,5, and 7days after operation, the existence of DLK and its Linebarger’s stage were examined with a slit-lamp. Fluorescein staining was also conducted to identify superficial punctate keratitis. Results: At 1 day postoperatively, 2 eyes had been excluded due to flap slipping. During 7 days follow-up, only stage I and II DLK occurred in 17 of 32 eyes (53.1%). No correlation between endotoxin level and the occurrence of DLK was observed. As for time course, the highest occurrence was at 5 days and 5 of 17 eyes (29.4%) were disappeared at 7 days. Two of 4 eyes that were stage II DLK at 3 to 4 days subsided to stage I. Conclusion: Mild DLK of stage I and II occurred with higher incidence in rabbit eyes treated with endotoxin. The appearance and the time course of DLK were similar to what we experience following LASIK.
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