Atopy: A patient-specific risk factor for diffuse lamellar keratitis

Objective: To identify whether atopy is a patient-specific risk factor for the development of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK). Design: Retrospective survey study. Participants: Three hundred sixty consecutive patients who underwent same-day bilateral myopic astigmatic primary LASIK procedures during March 1, 2000, through July 31, 2000. Methods: We collected data for 360 consecutive patients undergoing LASIK during a 4-month period. On preoperative medical history questionnaires, patients self-identified whether they were atopic. All patients also indicated whether they were taking antiallergy medications or were untreated for allergy. Main Outcome Measures: The incidence of DLK after LASIK surgery. Results: The risk of DLK in untreated atopic patients was much greater than the risk of DLK among nonatopics (odds ratio, 5.85; 95% confidence interval, 2.89-11.85; P = 0.001). However, the risk of DLK among atopic patients taking an oral systemic nonsedating histamine receptor 1 antagonist and among nonatopic patients did not differ significantly (odds ratio, 0.54; 95% confidence interval, 0.12-2.46; P = 0.43). Conclusions: Atopy is a patient-specific risk factor for the development of DLK after primary bilateral LASIK for either myopia or myopic astigmatism. Atopic individuals benefit from preoperative treatment to minimize the incidence of DLK and the potential for visual loss. (C) 2003 by the American Academy of Ophthalmology.