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Sporadic DLK attributed to endogenous factors
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SEATTLE — Many cases of sporadic diffuse lamellar keratitis can be attributed to endogenous factors that trigger inflammation, according to two surgeons.
Steven Wilson, MD, and Renato Ambrósio Jr., MD, suggest the hypothesis that the causes of sporadic DLK differ from those for epidemic DLK. They suggest that many cases of sporadic DLK are attributable to endogenous factors, while epidemic cases are likely associated with exogenous factors.
The surgeons reviewed the incidence and severity of DLK in 1,352 consecutive eyes that underwent primary LASIK for myopia or hyperopia and 217 eyes that underwent LASIK enhancements. Seventeen eyes that underwent primary LASIK developed DLK — 12 with stage 1 and five with stage 2. Three of the 217 enhancement eyes developed stage 1 DLK. All eyes responded to intensive corticosteroid therapy, with the addition of flap lifting and irrigation for the eyes with stage 2 DLK.
Endogenous factors that trigger the inflammation in sporadic cases may include the release of epithelium-derived cytokines that stimulate keratocytes. Epidemic DLK is likely associated with exogenous factors that stimulate inflammation, such as endotoxins contaminating sterilizer reservoirs or detergents on instruments, they said.
The study is published in the August issue of Cornea.