Diffuse Lamellar Keratitis (DLK): Can Fluoroquinolones Worsen DLK?

Abstract

Abstract: : Purpose: Diffuse lamellar keratitis (DLK) is an enigmatic inflammatory response that has been seen following LASIK. There have been many theories regarding its etiology. In our previous experiment, we were able to induce DLK under a LASIK flap using commercially-available topical fluoroquinolones in our NZW rabbit LASIK model. In this study, we examined whether fluorquinolones placed on the LASIK flap, as is used post-operatively for prophylaxis, would worsen DLK in the NZW rabbit LASIK-DLK model. Methods: One-half cross-section LASIK flaps were created using a Moria C-B automated microkeratome in both eyes of 30 New Zealand white rabbits. All rabbits had 500 units of Pseudomonas aeruginosa endotoxin (Sigma Chemical Co.) placed on the stromal bed prior to replacemet of the corneal LASIK flap. The rabbits were divided into 3 treatment groups: I) 0.3% ciprofloxacin (Ciloxan®, Alcon Laboratories, Inc.); II) 0.3% ofloxacin (Ocuflox®, Allergan, Inc.); and III) BSS® (Alcon Laboratories, Inc.). Treatment included instillation of one drop topical applicaton QID. Following treatment, eyes were examined via slit lamp and graded (Linebarger grading scale) in a masked fashion on post-operative day 1. Results: Duncan Multiple Comparison: ofloxacin = BSS < ciprofloxacin; p = 0.05 Conclusions: Diffuse lamellar keratitis was established, using endotoxin, in all rabbits in our NZW rabbit LASIK-DLK model. Ocuflox^TM demonstrated no effect on the severity of DLK while Ciloxan^TM appeared to worsen DLK in the NZW rabbit LASIK-DLK model. Based on the results of our model, Ciloxan^TM may worsen existing DLK in LASIK patients.  

Keywords: refractive surgery: complications • refractive surgery: LASIK • keratitis