Diffuse lamellar keratitis associated with recurrent corneal erosions after laser in situ keratomileusis.
OBJECTIVE
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.
Harrison
D A
DA
Department of Ophthalmology, University of Washington, Seattle 98195-6485, USA. dah@u.washington
Periman
L M
LM
D019573:Epithelium, Corneal / Q000473:pathology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007634:Keratitis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D009883:Ophthalmic Solutions; D011239:Prednisolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012008:Recurrence; D013524:Surgical Flaps
D005938:Glucocorticoids; D009883:Ophthalmic Solutions; C009935:prednisolone acetate; D011239:Prednisolone