Cleaning solutions as a cause of diffuse lamellar keratitis

Area of Science:

• Ophthalmology
• Corneal Surgery
• Ophthalmic Device Technology

Background:

• Diffuse lamellar keratitis (DLK) is a potential complication following laser in situ keratomileusis (LASIK).
• Microkeratome cleaning solutions are used to maintain surgical equipment but their potential to induce DLK requires investigation.
• Understanding the safety profile of cleaning solutions is crucial for ophthalmic surgical protocols.

Purpose of the Study:

• To evaluate the potential of two specific microkeratome cleaning solutions to induce diffuse lamellar keratitis (DLK).
• To assess this potential within a rabbit model simulating laser in situ keratomileusis (LASIK) surgery.

Main Methods:

• Two cleaning solutions, Palmolive and Cidezyme, were tested at manufacturer-recommended dilutions and a ten-fold greater dilution.
• A LASIK flap was created in 25 rabbits, and the corneal interface was exposed to study solutions or balanced salt solution (BSS) as a control.
• Postoperative examinations were conducted on days 1, 2, 3, 5, and 7 to assess for DLK and other complications.

Main Results:

• No instances of DLK-like interface inflammation were observed in any of the study groups.
• Complications such as flap displacement, retraction, and epithelial ingrowth occurred but were not significantly different across groups.
• Thirteen eyes were specifically evaluated for DLK, with none exhibiting signs of inflammation.

Conclusions:

• Microkeratome cleaning solutions, when diluted as recommended and properly rinsed with BSS, do not appear to cause DLK.
• These findings suggest that the tested cleaning solutions are safe for use in the corneal stromal interface during rabbit LASIK models.
• Adherence to manufacturer dilution and rinsing protocols is important for preventing intraoperative complications like DLK.