多酶洗涤剂对器械的浸泡洗涤导致SMILE术后弥漫性层间角膜炎

doi:10.3760/cma.j.cn115909-20190620-00178

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Abstract Objective: To investigate the potential causes,characteristics and management of the fulmination of diffuse lamellar keratitis (DLK) treated by small incision lenticule extraction (SMILE) surgery. Methods: Retrospective case series study. Three hundred and twelve eyes were treated by SMILE surgery in June 2018 to August 2018. The incidence, severity, clinical outcome, and treatments of DLK were analyzed. Results: The study enrolled 312 eyes treated by SMILE, and 69 eyes (22.1%) developed DLK. There were 45 eyes (65.2%) in the right eyes and 24 eyes (34.8%) in the left eyes. Of these DLK cases, 43 eyes (62.3%) were grade Ⅰ DLK; 18 eyes (26.1%) were grade Ⅱ; 7 eyes (10.1%) were grade Ⅲ; 1 eye (1.4%) were grade Ⅳ. Seven eyes of grade Ⅲ DLK on the first day after SMILE with layers flushing and hormones and antibiotics eye drops frequently using to achieved good results. One week postoperative, uncorrected visual acuity (UCVA) in 68 eyes reached preoperative best corrected visual acuity (BCVA). But 1 eye on the first day identified as grade Ⅱ DLK without interlayer rinse, only with hormones and antibiotics eye drops frequently dispensing was worsen rapidly into stage Ⅳ on the fifth day after SMILE. Until one year later, UCVA reached preoperative BCVA. Then we searched for risk factors of the outbreak of DLK. The bacterial cultures and the toxoid tests of the sterilized instruments were negative. The bacterial cultures of corneal intralamellar were negative too. After we replaced the perfusate and medical disposable materials, strengthened sterilization and isolation of operation room, and reduced the femtosecond laser energy, the DLK still appeared constantly. The outbreak of DLK stopped until we forbade using multienzyme detergents to marinate and clean the surgical instruments. Conclusions: Multienzyme detergents soaking and cleaning the instruments were the major causes of the mass DLK. We didn't recommend to use multienzymes detergents to marinate the preoperative instruments. An interface washout should be performed immediately due to the risks of permanent haze and scarring in the primer early postoperative severe DLK, besides adding the intensive topical steroids and antibiotics.

Key words： diffuse lamellar keratitis small incision lenticule extraction outbreak multienzyme detergents

Received: 20 June 2019

Corresponding Authors: Wei Chen, Department of Ophthalmology, Shenzhen Hospital of Peking University,Shenzhen 518036, China (Email: jennifercw6@163.com)

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https://www.cjoovs.com/EN/10.3760/cma.j.cn115909-20190620-00178 OR https://www.cjoovs.com/EN/Y2020/V22/I7/524

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