Diffuse lamellar keratitis after small-incision lenticule extraction.

PURPOSE

To determine the incidence and clinical features of diffuse lamellar keratitis (DLK) after small-incision lenticule extraction (SMILE).

SETTING

Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.

DESIGN

Retrospective case control study.

METHODS

Small-incision lenticule extraction for myopia was performed from September 1, 2011, to October 31, 2013. Preoperative clinical characteristics; treatment parameters; and intraoperative and postoperative complications, including the incidence, severity, clinical outcome, and resolution of DLK, were recorded. The independent t test, chi-square test, univariate repeated measures, and multivariate linear regression analysis were used to make statistical comparisons between eyes that developed DLK and those that did not.

RESULTS

The study enrolled 1112 eyes (590 patients). Eighteen eyes (1.6%) (11 patients) developed DLK. These patients presented 1 to 3 days postoperatively with mild to moderate inflammation. Thirteen eyes (72.2%) had stage 1 DLK, 4 (22.2%) had stage 2, and 1 (5.6%) had stage 3. After intensive treatment with topical corticosteroids, the stage 1 and stage 2 cases resolved within 3 weeks and the stage 3 case resolved in 1 month. The postoperative corrected distance visual acuity was the same or better than preoperatively in all eyes. There was a statistically significant increase in the incidence of DLK with thinner lenticules (P = .02) and larger diameter lenticules (P = .01), although multifactorial analysis showed lenticule thickness to be the only factor (P = .03).

CONCLUSIONS

Diffuse lamellar keratitis is a potential complication after small-incision lenticule extraction, although it had a low incidence. The risk factors for DLK must be further elucidated.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.