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Diffuse lamellar keratitis: evaluation of etiology, histopathologic findings, and clinical implications in an
Mike P Holzer1, Kerry D Solomon, David T Vroman
1Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Purpose:
To induce diffuse lamellar keratitis (DLK) and investigate the potential causative agents in an animal model.
Setting:
Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.
Methods:
In 70 eyes of 35 Dutch Belted rabbits, a corneal flap was cut and the interface randomly exposed to 1 of 7 substances: Pseudomonas aeruginosa endotoxin, 1 of 2 Staphylococcus aureus exotoxins, meibomian gland secretion, povidone-iodine 10%, Palmolive Ultra soap, and Klenzyme soap. Slitlamp examinations were performed 1, 3, 5, and 7 days postoperatively. The DLK was staged from 1 to 4. On day 7, the rabbits were killed and the eyes enucleated and processed for histopathologic examination.
Results:
At the end of the study, 54 eyes (46 exposed, 8 control) were available for evaluation. The 8 eyes studied concurrently in the control group remained clear and did not show interface inflammation. Thirty-one of 46 eyes (67%) treated with the various test substances developed DLK. The highest DLK rates were found with the cleaning soap Palmolive Ultra (100%; P =.022) and P. aeruginosa lipopolysaccharide endotoxin (90%; P =.026).
Conclusions:
Interface inflammation was consistently induced in the animal model. All 7 agents caused DLK in at least some eyes. The histopathologic evaluation showed the morphologic profile of the marked inflammatory cellular reaction that occurred in almost all the specimens.
Insights
This study induced diffuse lamellar keratitis (DLK) in rabbits using various agents. Household soaps and bacterial endotoxins were found to be significant triggers for DLK, highlighting potential risks in ophthalmic procedures.
Area of Science:
- Ophthalmology
- Veterinary Medicine
- Microbiology
Background:
- Diffuse lamellar keratitis (DLK) is a significant postoperative complication in refractive surgery.
- Identifying causative agents is crucial for preventing and managing DLK.
Purpose of the Study:
- To establish an animal model for inducing DLK.
- To investigate the potential of various substances to cause DLK.
Main Methods:
- Corneal flaps were created in rabbit eyes and the interface exposed to 7 substances, including bacterial endotoxins and household soaps.
- Eyes were examined postoperatively, and DLK was staged.
- Histopathological analysis was performed on enucleated eyes.
Main Results:
- Diffuse lamellar keratitis (DLK) was successfully induced in the animal model.
- Palmolive Ultra soap (100%) and Pseudomonas aeruginosa endotoxin (90%) showed the highest rates of DLK.
- All tested agents induced DLK in at least some eyes.
Conclusions:
- The rabbit model effectively simulates interface inflammation seen in DLK.
- Exposure to common household soaps and bacterial endotoxins can lead to DLK.
- Histopathology confirmed a significant inflammatory response in affected eyes.