Elias F. Jarade
The Dubai Mall Medical Center, UAE
Title: Treatment of grade IV Diffuse Lamellar Keratitis (DLK) with oral Doxycycline and topical 10% sodium citrate
Biography
Biography: Elias F. Jarade
Abstract
Purpose: To report a new treatment strategy of grade IV diffuse lamellar keratitis (DLK) based on topical 10% sodium citrate and oral doxycycline.
Methods: Six eyes of 3 patients with stage IV DLK after LASIK, were treated with the same treatment protocol of 10% topical sodium citrate 6 times a day for 4 weeks and 100 mg oral doxycycline twice daily for 2 weeks then once daily for three months, along with topical steroid drops for one week then tapered gradually over one month. Assessment of response to treatment was done in terms of visual acuity, anatomical and keratometric recovery for the period of follow up ranging from 1 to 8 years.
Results: Follow-up visits showed improvement in all eyes, starting at 2 weeks, with an improvement in UCVA, a decrease in hyperopia and in the central corneal infiltrates. Progressive improvement was documented during the follow up. At 1 year, the outcome regarding UCVA, hyperopia and clinical findings was excellent reaching 20/30 to 20/20 OU, with residual hyperopia of +0.25 D to +1.25 D and a complete resolution of the central infiltrates.
Conclusion: This is the first report of successful treatment of stage IV DLK. Topical sodium citrate 10% and oral doxycycline seem to target the main pathophysiology of the disease through their mechanism of anti-collagenolytic activities. This new treatment strategy might be considered in the treatment of corneal inflammatory conditions characterized by increased collagenolytic activities after LASIK.
Precis: In stage IV DLK, stromal collagen is digested by collagenolytic enzymes. We report a new treatment strategy of grade IV DLK, based on topical sodium citrate and oral doxycycline with good anatomical and functional outcomes.