Diagnosis, Clinical Trend, and Treatment of Diffuse Lamellar Keratitis after Femtosecond Laser-Assisted in situ Keratomileusis: A Case Report

Abstract

We report a severe case of diffuse lamellar keratitis (DLK) following femtosecond laser-assisted in situ keratomileusis (femto-LASIK). A 25-year-old man was submitted to 150 kHz iFS® IntraLase-assisted LASIK in both eyes for compound myopic astigmatism. The day after surgery, clinical examination showed a diffuse whitish granular cell reaction particularly in the right eye. High-dose dexamethasone eyedrops with topical antibiotic and artificial tears were prescribed. Five days after surgery, a central corneal opacity with convergent striae was detected at biomicroscopy. The suspicion of DLK was confirmed. Additional therapy based on hyperosmolar ophthalmological solution, oral doxycycline, and topical 10% sodium citrate was prescribed. Treatment was continued and tapered for over 3 months. Improvement in corneal transparency were obtained 2 weeks after the systemic therapy had been started. Uncorrected visual acuity improved from 20/32 to 20/20 at 1-year follow-up. DLK represents an infrequent complication after femto-LASIK. It should resolve without sequelae if promptly diagnosed and treated, without necessity of corneal flap lifting.

Diffuse lamellar keratitis associated with tabletop autoclave biofilms: case series and review

“…Moreover, our ability to culture these microbes after an extended period of dry storage reflects the tenacity with which bacterial subpopulations are able to survive in a dormant state within a biofilm. 68,69 61 1 Corneal blood vessels Not mentioned Abdelmaksoud et al 62 2 (CTK) Not determined Not mentioned Balestrazzi et al 63 1 Not attributed Not mentioned Sorenson (this paper) 147/395 Reservoir contamination Attributed to autoclaves DLK = diffuse lamellar keratitis; CTK = central toxic keratopathy; LASIK = laser in situ keratomileusis * Statim autoclave noted to be the autoclave in use and author suggests autoclave may be related to the DLK outbreak. Several authors suspect the autoclave, but many studies, including larger reviews, do not mention the possible role of the autoclave reservoir.…”

“…Forty case reports, reviews, and other articles in the peerreviewed literature between 1986 and 2019 relating to the topic of TASS (Table 3). Another 22 reports and articles on DLK [1][2][3][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] (Table 4) were identified. Only 5 of these 62 total studies reported specifically investigating the potential role of autoclave reservoirs and their associated biofilms as the potential cause of TASS or DLK.…”

One-Year Visual and Refractive Outcomes following LASIK for Myopia and Myopic Astigmatism with MEL 90 versus Schwind Amaris 750S Excimer Laser: A Comparative Study

“…Patients were observed for possible flap related complications including microfolds, epithelial ingrowth, interface haze, interface debris, infection, superficial punctate keratitis, and diffuse lamellar keratitis at each visit using a 6-grade classification system: trace, GD I-II (not visually significant), and GD III-V [ 11 , 12 ].…”

Optical Coherence Tomography for Diagnosis and Treatment of Corneal Diseases

“…Как известно, длительный послеоперационный отек роговицы при LASIK может быть обусловлен различными причинами. ОКТ позволяет оценить зону интерфейса и выявить такие изменения, как хейз и скопление внутриглазной жидкости [48], а также исключить наличие гиперрефлектирующих зон -возможного признака развития интраламмелярного кератита [49].…”