Five-Year Incidence, Management, and Visual Outcomes of Diffuse Lamellar Keratitis after Femtosecond-Assisted LASIK

Majid Moshirfar; Kathryn M Durnford; Adam L Lewis; Chase M Miller; David G West; R Alek Sperry; William B West Jr; Kathryn M Shmunes; Shannon E McCabe; MacGregor N Hall; Yasmyne C Ronquillo; Phillip C Hoopes

doi:10.3390/jcm10143067

Five-Year Incidence, Management, and Visual Outcomes of Diffuse Lamellar Keratitis after Femtosecond-Assisted LASIK

J Clin Med. 2021 Jul 11;10(14):3067. doi: 10.3390/jcm10143067.

Authors

Majid Moshirfar^{1

2

3}, Kathryn M Durnford⁴, Adam L Lewis⁵, Chase M Miller⁶, David G West⁷, R Alek Sperry⁷, William B West Jr⁴, Kathryn M Shmunes^{1

8}, Shannon E McCabe^{1

9}, MacGregor N Hall⁶, Yasmyne C Ronquillo¹, Phillip C Hoopes¹

Affiliations

¹ Hoopes Vision, HDR Research Center, 11820 S. State Street Suite #200, Draper, UT 84020, USA.
² John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, Salt Lake City, UT 84132, USA.
³ Utah Lions Eye Bank, Murray, UT 84107, USA.
⁴ School of Medicine, University of Utah, Salt Lake City, UT 84132, USA.
⁵ College of Osteopathic Medicine, Kansas City University, Kansas City, MO 64106, USA.
⁶ McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
⁷ Brigham Young University, Provo, UT 84602, USA.
⁸ Department of Ophthalmology, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL 32209, USA.
⁹ Mission Hills Eye Center, Pleasant Hill, CA 94523, USA.

Abstract

Femtosecond (FS) lasers initially had a higher incidence of diffuse lamellar keratitis (DLK) compared with microkeratome flap creation. It has been theorized that higher-frequency lower-energy (HFLE) FS lasers would reduce the incidence of DLK. Our study sought to evaluate the incidence of newer HFLE FS lasers with pulse frequencies above 60 kHz. It was a retrospective case-control study evaluating the incidence of DLK following flap creation with one of three FS lasers (AMO iFs, WaveLight FS200, Zeiss VisuMax). Uncomplicated LASIK cases were included as the control group (14,348 eyes) and cases of DLK were recorded in the study group (637 eyes). Of the 637 cases of DLK, 76 developed stage II, 25 progressed to stage III, and only three developed stage IV DLK. The overall incidence rate of DLK was 4.3%; it has fallen with the invention of newer HFLE FS lasers and is approaching the DLK incidence rates of DLK with microkeratome.

Keywords: LASIK; diffuse lamellar keratitis (DLK); femtosecond; incidence.

Grants and funding

n/a/Research to Prevent Blindness