Late-onset idiopathic diffuse lamellar keratitis after laser in situ keratomileusis

Abstract

We report a case of late-onset diffuse lamellar keratitis (DLK) in the left eye of a 56-year-old white woman 3 years after uneventful bilateral laser in situ keratomileusis (LASIK). Slitlamp examination revealed stage 3 DLK with diffuse, multifocal, dot-like, and granular haze in the interface. The DLK did not have an obvious causative agent such as trauma or epithelial defects and responded rapidly to topical corticosteroid therapy. Surgery was performed to relift the flap, remove cellular infiltrates, and obtain cultures. The microbiology culture was negative. This case indicates that DLK can occur several years after LASIK without an obvious cause.

A case of late-onset diffuse lamellar keratitis 12 years after laser in situ keratomileusis

“…[2][3][4][5] As far as we can ascertain, our case is the most delayed onset of DLK reported, appearing 12 years after LASIK. Although the precise mechanism of the disease is not fully understood, several possible etiologies, including metallic debris from either the microkeratome or blade, bacterial endotoxins, meibomian gland oils, debris from corneal ablation or from absorbent sponges, povidone- iodine solutions, surgical glove talc, and epithelial defects, have been reported so far.…”

“…Although the precise mechanism of the disease is not fully understood, several possible etiologies, including metallic debris from either the microkeratome or blade, bacterial endotoxins, meibomian gland oils, debris from corneal ablation or from absorbent sponges, povidone- iodine solutions, surgical glove talc, and epithelial defects, have been reported so far. Although Jin et al 4 described a case of idiopathic DLK 3 years after uneventful LASIK, late-onset DLK has been associated with infl ammatory conditions such as iritis, 2 bacterial or viral keratoconjunctivitis, 3 and interstitial keratitis. 5 Lyle and Jin.…”

Diffuse lamellar keratitis associated with gonococcal keratoconjunctivitis 3 years after laser in situ keratomileusis

“…In the other case of DLK occurring 3 years post LASIK, no obvious trigger was evident. 17 In summary, we present the first reported case of DLK in the presence of acute goncoccal ocular infection. In this case, DLK may have occurred because of the presence of the infectious antigen or as a secondary consequence of the inflammatory process.…”

“…Second, having occurred 3 years after surgery, it is the second-longest reported interval of DLK onset after LASIK. 17 We do not know whether the DLK was caused directly by the presence of gonococcal antigen, such as endotoxin at the flap interface, or whether the intense inflammatory reaction alone was sufficient to cause an accumulation of inflammatory infiltrate and DLK. It is noteworthy that endotoxin has been implicated in the pathogenesis of earlyonset DLK.…”

Late-onset diffuse lamellar keratitis after surface ablation

“…There was no discharge or anterior chamber reaction, and the patient responded to topical steroid treatment, all of which were indicative of DLK. 5 Diffuse lamellar keratitis is a dreaded complication after LASIK surgery that is often caught and successfully treated due to vigilant observation of patients in the early postoperative period. Photorefractive keratectomy has not been associated with DLK, and this complication is not usually considered.…”