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KD Solomon, MP Holzer, HP Sandoval, LG Vargas, TJ Kasper, DT Vroman, DJ Apple; Postoperative Prophylactic Treatment for Diffuse Lamellar Keratitis: An Experimental Animal Model . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2108.
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Purpose: Diffuse lamellar keratitis (DLK) is a multifactorial disease that can be seen following laser in situ keratomileusis (LASIK). To further investigate this complication we created an animal model in rabbit eyes. The aim of this study was to evaluate in this model 4 different topical medications for postoperative prophylaxis of DLK. Methods: In a prospective, randomized and masked study a nasal corneal flap was cut in 80 eyes of 40 Dutch-belted rabbits and the interface inoculated with either Pseudomonas aeruginosa LPS endotoxin or Palmolive® Ultra soap. These agents were found to cause DLK at a rate of 90% and 100%, respectively during a previous study in 20 rabbit eyes. These eyes were used as a control. Postoperatively the rabbits were treated during a 1-week period 4x/day with one of the following topical medications: Group A) antihistamine/mast cell stabilizer; group B) nonsteroidal anti-inflammatory drug (NSAID); group C) fluoroquinolone antibiotic; group D) corticosteroid. Slit lamp examinations and photodocumentation were performed 1, 3, 5 and 7 days postoperatively and DLK rates and intensity of the groups were analyzed and compared. Results: Sixty-three out of the 80 treated eyes (79%) were available for evaluation. In the control group, 17 out of 20 eyes were evaluated. Twenty eyes had either slipped or free flaps. The highest DLK rate in treated eyes (86%) was found in group A, followed by group C (76%), group D (63%) and group B (56%). When compared to the untreated eyes, treatment group B and D showed a significantly lower DLK rate (P < 0.05; Fisher's Exact Test). Conclusions: With the establishment of this experimental animal study we were able to evaluate different postoperative prophylactic treatments for DLK. The results of this study suggest that a prophylactic postoperative treatment with a nonsteroidal anti-inflammatory drug (NSAID) or a corticosteroid can lower the incidence of DLK.
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