prophylactic topical steroids prior to lasik for prevention of diffuse lamellar keratitis (dlk)

purpose: to evaluate the role of prophylactic topical steroids in the prevention of dlk after lasik. methods: in a randomized double blind clinical trial, 101 lasik candidates aged 18 to 55 years were enrolled. myopia ranged from -2 to -12 diopters and was stable for at least one year. no patient had any ocular or systemic contraindication for lasik. from one day before surgery, topical betamethasone 0.1% was randomly applied for one eye every 4 hours while the other eye received placebo. one hour before surgery the dosage was increased to every 5 minutes for at least six times. all operations were performed by one surgeon (f.k). both eyes were operated in one setting. six hours after surgery, all the eyes were put on topical betamethasone every 2 hours and dosage was tapered depending on the response and according to the grade of dlk if present. severity of dlk was graded according to the linebarger-lindstorm classification. patients were regularly examined in the first week and if the postoperative course was uneventful they were re-examined one and three months after surgery. vision (bcva), refraction (cyclorefraction), and severity of dlk were documented by a third examiner at each visit.   results: one hundred eyes were in the treatment and 98 eyes were in the control group. in both groups, pre and post lasik refraction and va were comparable (p> 0.05). there were no significant complications in both groups during or after lasik except for dlk. dlk was seen in 55 eyes (55%) of the treatment group including 44 eyes (44%) with grade i and 11 eyes (11%) with grade ii. in the control group dlk was seen in 36 eyes (36.7%) of which 29 eyes (29.5%) were grade i, and 7 eyes (7.2%) were grade ii. there was no statistically significant difference between the incidence of dlk in the two groups (p= 0.81). more severe grades of dlk (iii and iv) were not seen in any group. conclusion: although steroids (topical and systemic) play a key role in the treatment of dlk, they seem to have no inhibitory role on dlk.