Diffuse lamellar keratitis after laser in situ keratomileusis associated with surgical marker pens

To describe a series of cases of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) associated with intraoperative use of a surgical marker pen.

Singapore National Eye Centre, Singapore, Singapore.

A review of all 115 patients (125 eyes) who had myopic LASIK from July 23 to July 26, 2007, was performed to determine whether eyes in which the Codman surgical marker pen (Johnson & Johnson Medical) was used intraoperatively developed postoperative DLK.

Nine of 12 eyes that had LASIK or flap relifting with a Codman surgical marker pen developed grade 1 to grade 3 DLK on the first postoperative day. The 113 other eyes that had LASIK in the same week with another brand of surgical marker pen (Securline, Precision Dynamics Corp.) did not develop DLK. All eyes with DLK were treated with intensive topical steroid therapy. The DLK resolved in 2 eyes after the steroid treatment; 7 eyes required flap relifting with interface irrigation. One month postoperatively, 6 eyes with DLK had an uncorrected visual acuity of 6/7.5 or better. Two eyes developed central corneal scarring with consecutive hyperopia with a best corrected visual acuity of 6/12 after 1 month.

There was a strong association between the occurrence of DLK after LASIK with the use of the Codman surgical marker pen. One or more constituents of the ink in the Codman pen may have been responsible for this series of cases.