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Topical and systemic steroids effective for severe DLK, surgeon says

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SAN FRANCISCO — Combined topical and oral corticosteroids effectively manage severe cases of diffuse lamellar keratitis and may be a convenient alternative to flap lifting and interface irrigation, according to a study presented here.

After successfully treating an outbreak of DLK, Richard S. Hoffman, MD, reviewed the last 1,000 consecutive LASIK cases performed at his practice. He said all DLK patients were successfully treated with topical and systemic corticosteroids. No patients required flap lifting and interface irrigation, the standard treatment for cases of stage 3 and higher DLK.

According to Dr. Hoffman, the results of the study support the use of a noninvasive approach to managing severe cases of DLK.

The outbreak he experienced resulted in a 4% incidence of DLK (40 cases). Oral prednisolone and topical Pred Forte (prednisone acetate, Allergan) were used in all patients who developed stage 3 DLK and those patients who exhibited stage 2 DLK on the first postoperative day and thus appeared at risk for progressing to stage 3.

According to Dr. Hoffman, 55% of all eyes treated for DLK received oral steroids and the majority of these patients were started on steroids by the fourth postoperative day.

Twenty-five percent of the DLK patients did not progress past stage 1. Stage two was the most common maximum DLK stage reached, with 48% of patients progressing to it. Seventeen percent of patients progressed to stage 3.

There was an overall mean hyperopic shift of 0.14 D, which Dr. Hoffman said was essentially negligible. A subanalysis of eyes with stage 3 DLK (7 eyes) showed these patients also experienced a negligible mean hyperopic shift (0.10 D).

No patients experienced corneal scarring or a loss of best corrected visual acuity. However, 43% of eyes with stage 3 DLK had associated corneal abrasions, which suggests corneal abrasions are a significant risk factor for developing severe DLK, Dr. Hoffman said.

For more on Dr. Hoffman’s study, see the Jan. 1, 2003 print edition of Ocular Surgery News.