Topical Steroids for Prevention of Diffuse Lamellar Keratitis Following LASIK

PURPOSE: To determine the role of prophylactic topical steroids in the prevention of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK). METHODS: This randomized double blind clinical trial included consecutive LASIK candidates aged 18 to 55 years with stable (1 year or more) myopia ranging from -2 to -12 diopters. The day before surgery, eyes were randomly allocated to topical betamethasone 0.1% or placebo every four hours. One hour preoperatively, the dosage was increased to every five minutes for at least six times. DLK was graded according to the Linebarger-Lindstorm classification. Patients were examined one week and one and three months after surgery. Best-corrected visual acuity (BCVA), manifest and cycloplegic refraction and severity of DLK were documented at each visit by a masked examiner. RESULTS: Overall, 198 eyes (100 in the treatment group and 98 in the control group) of 101 patients (97 bilateral and 4 unilateral cases) were operated. Pre- and post-LASIK refraction and BCVA were comparable in the study groups (P > 0.05). There were no significant complications in either group during or after LASIK except for DLK which developed in 55 eyes (55%) of the treatment group including 44 eyes with grade I and 11 eyes with grade II, versus 36 eyes (36.7%) of the control group including 29 eyes with grade I and 7 eyes with grade II DLK (P= 0.81). CONCLUSION: Although steroids play a key role in the treatment of DLK, pretreatment with topical steroids 24 hours prior to LASIK does not seem prevent this complication.