Stage IV DLK prognosis excellent with new approach to therapy

Loma Linda, CA-Recovery of full visual function is possible in eyes with stage IV diffuse lamellar keratitis (DLK) using a novel management paradigm that is based on a new pathophysiologic model of the disorder, said Brian R. Will, MD, assistant clinical professor of ophthalmology, Loma Linda University School of Medicine, Loma Linda, CA.

The clinical manifestations of stage IV DLK, including the flap macrostriae, stromal opacity, and hyperopic shift, are the result of focal flap and anterior stromal edema secondary to keratocyte dysfunction rather than a consequence of necrotic tissue loss, Dr. Will proposed. He described a management technique that is directed first at eliminating the edema followed later by flap lifting and stretching to eliminate the macrostriae. Finally, laser enhancement is performed as needed to correct any residual refractive error.

Use of that protocol in a consecutive series of eight eyes of six patients with stage IV DLK after all-laser LASIK (IntraLASIK) resulted in a final visual acuity outcome of 20/20 or better in all cases, reported Dr. Will, who is also medical director, Will Vision and Laser Centers, Vancouver, WA.

Even before the enhancement, all eyes had excellent uncorrected visual acuity (UCVA), and at the last available follow-up, UCVA and BCVA were 20/20 or better in all eyes. No eyes experienced any loss of BCVA, and no patients complained of problems with glare, halos, or other unwanted visual effects at the conclusion of therapy.

Keratocyte dysfunction