The environmental factor
Sterility of the operating room and the
instruments can also play a factor in DLK

If the surgical suite where LASIK is performed is not completely sterile, contaminants in the suite could cause DLK, clinicians said. “The first thing surgeons should ask if they notice an outbreak is what has changed in the routine or the operating room,” Dr. Binder said.
One of the first culprits associated with an increased DLK rate in Dr. Binder’s practice was the sterilizers, he said. Even though the instruments were sterilized, “the endotoxins on the cell walls remained. The reusable cannulas were associated with the DLK, so now we use disposable cannulas.”
Environmental factors such as dust, mold, or fungus in the air can be eliminated by installing ventilation systems, recommendations from ASCRS suggest.
“There have been reports of surgical glove powder contamination,” Dr. Stahl said. “It doesn’t surprise me that if there’s dust in the environment it could get under the flap, but most LASIK suites have a ventilation system.”
Dr. Majmudar added that while he’s heard of individual cases, he’s never experienced an environmental cause for DLK, but doesn’t discount the possibility. “What we’ve heard about are sterilizers not cleaned properly, instrument transferal that could cause the cornea to become more inflamed. There could be something in the surgical suite that gets onto the interface and causes an allergic or immunologic response,” he said. “Anything out of the ordinary or norm interacting with the cornea can result in DLK. There are numerous reasons why it can occur, but it’s mostly just conjecture at this point.”