title: Confocal microscopic characteristics of stage 1 to 4 diffuse lamellar keratitis after laser in situ keratomileusis.
abstract: OBJECTIVE
  To evaluate 4 stages of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis using confocal microscopy.
  
  
  METHODS
  Department of Ophthalmology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
  
  
  METHODS
  This retrospective study comprised 17 eyes (15 patients): 11 cases of stage 1 DLK, 5 cases of stage 2, 1 case of stage 3, and 2 cases of stage 4. All eyes were examined by slitlamp biomicroscopy and confocal microscopy.
  
  
  RESULTS
  In all cases of stage 1 and 2 DLK, confocal microscopy showed infiltration of inflammatory cells into the flap stroma and the interface. The density of the infiltrates and the number of cells varied within the stage 1 corneas; all stage 2 corneas had dense infiltrates. In the eye with stage 3 DLK, an aggregation of presumed cell remnants was noticed. In the stage 4 cases, there was no active inflammation but stromal folds and numerous activated keratocytes were detected.
  
  
  CONCLUSIONS
  Confocal microscopy showed differences in the appearances of the DLK groups. There were similarities in the features of stages 1 and 2. Only stages 1 and 2 represented active inflammation, whereas stages 3 and 4 showed the result of accumulation and decay of the inflammatory cells.
authors.affiliation: Department of Ophthalmology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. kohnen@em.uni-frankfurt.de
authors.forename: Jens
authors.initials: J
authors.lastname: Bühren
authors.forename: Martin
authors.initials: M
authors.lastname: Baumeister
authors.forename: Magdalena
authors.initials: M
authors.lastname: Cichocki
authors.forename: Thomas
authors.initials: T
authors.lastname: Kohnen
mesh_terms: D000328:Adult; D003315:Cornea / Q000473:pathology; D003319:Corneal Stroma / Q000473:pathology; D005260:Female; D006801:Humans; D007634:Keratitis / Q000473:pathology* / Q000601:surgery*; D020731:Keratomileusis, Laser In Situ; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies