Diffuse lamellar keratitis associated with recurrent corneal erosions after laser in situ keratomileusis

J Refract Surg. Jul-Aug 2001;17(4):463-5.

Abstract

Purpose: Diffuse lamellar keratitis (DLK) is marked by the presence of diffuse or multifocal infiltrates confined to the laser in situ keratomileusis (LASIK) interface. These infiltrates are culture-negative, and the etiology is thought to be noninfectious. Most cases of DLK occur within the first week or two following surgery.

Methods: We describe one case of diffuse lamellar keratitis that occurred 3 months after LASIK. The patient developed a spontaneous corneal erosion in one eye. Over the next 2 days while the erosion was being treated, there was rapid development of DLK. Slit-lamp biomicroscopy and in vivo scanning slit confocal microscopy were performed. The patient was treated with intensive topical corticosteroids.

Results: Scanning slit confocal microscopy revealed numerous, highly-reflective round bodies consistent with a polymorphonuclear infiltrate located at the flap interface. Treatment with topical 1.0% prednisolone acetate was instituted, with rapid improvement in patient symptoms, visual acuity, and slit-lamp biomicroscopy.

Conclusions: Diffuse lamellar keratitis may occur months after LASIK as a result of a spontaneous recurrent corneal epithelial erosion.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Epithelium, Corneal / pathology*
  • Glucocorticoids / therapeutic use
  • Humans
  • Keratitis / drug therapy
  • Keratitis / etiology*
  • Keratitis / pathology
  • Keratomileusis, Laser In Situ / adverse effects*
  • Male
  • Microscopy, Confocal
  • Middle Aged
  • Neutrophils / pathology
  • Ophthalmic Solutions
  • Prednisolone / analogs & derivatives*
  • Prednisolone / therapeutic use
  • Recurrence
  • Surgical Flaps

Substances

  • Glucocorticoids
  • Ophthalmic Solutions
  • prednisolone acetate
  • Prednisolone