J Cataract Refract Surg. 2008 Jul;34(7):1121-4.

Outbreak of diffuse lamellar keratitis caused by marking-pen toxicity.

Hadden OB, McGhee CN, Morris AT, Gray TB, Ring CP, Watson AS.
From the Eye Institute, Auckland, New Zealand.

PURPOSE: To examine the evidence that a series of cases of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) was caused by a type of marker pen.

SETTING: Eye Institute, Auckland, New Zealand.

METHODS: During a 10-week period, 522 consecutive LASIK procedures were performed using a 60 Hz IntraLase femtosecond laser (IntraLase Corp.) to create the LASIK flap and a 217Z 100 Hz excimer laser (Bausch & Lomb) to perform the refractive ablation. As standard practice, a marking pen was used to enable accurate flap realignment. Three weeks after a sudden increase in the incidence of DLK was identified, one of the 5 surgeons performed 5 consecutive bilateral cases using the marking pen in the right eyes but not in the left eyes.

RESULTS: Of the 522 LASIK cases (119 without marking pen, 403 with marking pen), DLK developed in 49 (9.4%). No eye treated without the marking pen developed DLK; of those in which the marking pen was used, 49 (12.2%) developed DLK (P<0.0001, Fischer exact test; odds ratio, 27). In the 5 consecutive bilateral cases in which the marking pen was used in the right eye but not the left eye, 4 right eyes and no left eye developed DLK (P = 0.03). Forty-five of the 49 eyes with DLK quickly recovered. The other 4 developed central toxic keratopathy.

CONCLUSION: There is strong statistical evidence that the marking pen was a factor in the occurrence of DLK.

The source is not a peer-reviewed journal.

Endothelial cell loss associated with diffuse lamellar keratitis after LASIK






Source: OSNSupersite, September, 2009
http://www.osnsupersite.com/view.aspx?rid=43248

17% incidence of DLK using IntraLase femotsecond laser.


Jaime Javaloy, MD, PhD; María T. Vidal, MD, PhD; Ayman M. Abdelrahman, MD; Alberto Artola, MD, PhD and Jorge L. Alió, MD, PhD. Confocal Microscopy Comparison of IntraLase Femtosecond Laser and Moria M2 Microkeratome in LASIK. Journal of Refractive Surgery Vol. 23 No. 2 February 2007

"Diffuse lamellar keratitis consists of a multi-etiologic syndrome that expresses variable degrees of inflammation at the interface of eyes operated by LASIK.37,38 As DLK after LASIK using a femtosecond microkeratome has not been reported previously, the 17% prevalence rate of this syndrome (even considering that just 6.25%—1 case—was greater than grade I or II) in our series has to be taken into account."

J Cataract Refract Surg. 2009 Nov;35(11):2018-21.
Surgical flap amputation for central flap necrosis after laser in situ keratomileusis.
Garcia-Gonzalez M, Gil-Cazorla R, Teus MA.

"The incidence of DLK after LASIK performed with a mechanical microkeratome is well documented (0.67% to 4%),2 although the incidence of DLK after LASIK performed with the IntraLase femtosecond laser (Abbott Medical Optics) is higher (17% to 19%),3 probably due to a more intensive inflammatory response after the procedure.4"