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2002 Ocular Microbiology and Immunology Group, Abstract 9

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Diffuse Lamellar Kerititis: Can Fluoroquinolones Be a Cause?
FS Mah, DK Dhaliwal, EG Romanowski, KA Yates, YJ Gordon. Charles T. Campbell Laboratory, University of Pittsburgh, Pittsburgh, PA

Purpose: Diffuse lamellar keratitis (DLK) is an enigmatic inflammatory response that has been seen following LASIK. There have been many theories regarding its etiology. To date, commercially available topical fluoroquinolones have not been implicated as a potential cause of DLK. In this study, we examined whether fluoroquinolones placed under the LASIK flap will induce DLK in the NZW rabbit LASIK model.

Methods: One-half cross-section LASIK flaps were created using a Moria C-B automated microkeratome in both eyes of 40 New Zealand white rabbits. The rabbits were divided into 4 treatment groups: I) 0.3% ciprofloxacin (Ciloxan®, Alcon Laboratories, Inc.); II) 0.3% ofloxacin (Ocuflox®, Allergan, Inc.); Ill) BSS® (Alcon Laboratories, Inc.); and IV) Pseudomonas aeruginosa endotoxin (Sigma Chemical Co.). Treatment included instillation of one drop under the flap and topical application QID the following day. Following treatment, eyes were examined via slit lamp and graded (Linebarger grading scale) in a masked fashion on post-operative day 1.

Results:
Group
Number of Eyes
With Significant DLK*
Median
DLK Score**
Mean ± SD
DLK Score
0.3% Ciprofloxacin
14/20 (70%)
1.0
1.3 ± 0.9
0.3% Ofloxacin
8/20 (40%)
0.5
0.8 ± 0.9
BSS
4/19 (21%)
0.5
0.4 ± 0.5
Endotoxin
9/20 (45%)
0.5
1.0 ± 1.0
*Chi-square p=0.0216; **Kruskal-Wallis ANOVA p=0.020

Conclusion: Fluoroquinolones placed on the stromal bed prior to replacement of the corneal flap after simulated LASIK surgery appear to induce the formation of DLK in the NZW rabbit LASIK model. Ocuflox™ appears to induce less DLK than Ciloxan™ in the NZW rabbit LASIK model. The placement of fluoroquinolones directly onto the stromal bed prior to the replacement of the corneal flap during LASIK surgery may be a cause of enigmatic DLK in patients.

Support: Allergan Corp, and RPB.

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