[Evaluation of diffuse lamellar keratitis after LASIK with confocal microscopy].
OBJECTIVE
To investigate the clinical pathologic characteristics and the pathogenesis of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK).


METHODS
On 30 patients with 39 eyes being diagnosed with DLK (grade I-grade IV) after LASIK, slit-lamp examinations were performed 1, 3, 5, 7 and 30 days postoperatively, and scanning slit confocal microscope in vivo were performed 3, 7 and 30 days postoperatively.


RESULTS
Typical characteristics of grade I and grade II DLK by confocal microscope examination showed up at 3 days postoperatively. We found that the epithelium, the posterior stroma and the endothelium were normal. In the lamella in front of the incision, many round or oval-shaped cells with diameter of approximately 12 approximately 20 microm were detected. These cells had eccentric, highly reflective nuclei and less reflective intracellular structures. They were most likely to be mononuclear cells. These cells distributed diffusely or arranged in line shape. In the lamella, clusters and lines of small, highly reflective, irregular shaped cells 8 to 10 microm in diameter were seen. They were similar to granulocytes or lymphocytes. Seven days postoperatively, these cells almost disappeared. Grade III DLK appeared from 3 to 5 days postoperatively, with more dense infiltration and more highly reflective irregular shape materials in the lamella. Grade IV DLK appeared 5 to 7 days postoperatively. Anterior stroma structure became unclear, with highly reflective and folded corneal flap. Numerous highly reflective scarring formed late.


CONCLUSIONS
DLK after LASIK is a inflammatory response in corneal lamella, its typical pathologic characteristic is inflammatory cells infiltration in the lamella. Several factors work together to cause DLK through endogenous and exogenous mechanisms.
Guo
Ning
N
Tongren Ophthalmic Center, Capital University of Medical Sciences, Beijing 100730, China. eguoning@163.com
Zhou
Yue-hua
YH
Qu
Jia
J
Pan
Zhi-qiang
ZQ
Wang
Li
L
D003315:Cornea / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007634:Keratitis / Q000209:etiology / Q000473:pathology*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D018613:Microscopy, Confocal