Topical intrastromal steroid during laser in situ keratomileusis to retard interface keratitis

Abstract Purpose To evaluate the effect of an intraoperative topical intrastromal steroid on the incidence and severity of nonspecific diffuse intralamellar keratitis (NSDIK). Setting T.L.C. The Laser Center, Brea, California, USA. Methods This prospective study included 2 cohort groups, each consisting of 105 consecutive eyes treated with laser in situ keratomileusis (LASIK) for myopia and astigmatism. Group A received the standard LASIK medication protocol and Group B, an additional drop of prednisolone sodium phosphate 1% solution on the undersurface of the cap immediately after it was reflected, prior to initiating the laser treatment. After the laser treatment was completed, the flap was repositioned; 1 minute after the steroid application, the interface was irrigated. All patients were examined postoperatively and placed in 1 of 4 categories: no interface keratitis, grade 1 (mild), grade 2 (moderate with decreased vision), or grade 3 (severe with decreased vision). Results The incidence of NSDIK in Group A was 17.1% (18 eyes); 14 eyes (78.0%) were grade 1 and 4 (22.0%), grade 2. The incidence in Group B was 6.7% (7 eyes); all eyes were grade 1. Topical intrastromal steroid application significantly reduced the incidence and severity of NSDIK ( P Conclusion We propose that intraoperative intrastromal steroid application is a safe and effective way to reduce the incidence and severity of NSDIK.