Spontaneous Bilateral, Recurrent, Late-onset Diffuse Lamellar Keratitis After LASIK in a Patient With Cogan's Syndrome

Abstract

<H4>PURPOSE</H4> <P>To report a patient with severe and progressive bilateral deafness who suffered recurrent episodes of diffuse lamellar keratitis (DLK) in both eyes ≥4 months after undergoing uneventful LASIK for myopia.</P> <H4>METHODS</H4> <P>Four months after LASIK, the patient presented with blurred vision in the left eye. Best spectacle-corrected visual acuity was 0.9. Slit-lamp examination revealed aggregates of white cells at the paracentral and mid-peripheral interface without affecting the visual axis. Diffuse lamellar keratitis stage II was diagnosed and intensive corticosteroid treatment was started. Uncorrected visual acuity (UCVA) in the right eye was 1.2 with no signs of DLK.</P> <H4>RESULTS</H4> <P>One week after initiating corticosteroid treatment, UCVA improved (1.2) in the left eye. Diffuse lamellar keratitis was diagnosed in the left eye again at 9 months and in the right eye at 15 months after LASIK. The patient was later diagnosed with atypical Cogan’s syndrome.</P> <H4>CONCLUSIONS</H4> <P>Recurrent and late-onset DLK may be due to other patient systemic conditions predisposing to interstitial keratitis, such as Cogan’s syndrome. [<CITE>J Refract Surg.</CITE> 2008;24:548-550.]</P> <H4>ABOUT THE AUTHORS</H4> <P>From the Department of Cornea and Refractive Surgery, VISSUM, Instituto Oftalmológico de Alicante, Miguel Hernández University School of Medicine, Alicante, Spain (Javaloy, Muñoz, Pérez-Santonja, Vidal, Alió); and Otorhino-Laringology Department, Fundación Hospital de Torrevieja, Torrevieja, Spain (Barrera).</P> <P>The authors have no proprietary interest in the materials presented herein.</P> <P>Correspondence: Jaime Javaloy, MD, PhD, Instituto Oftalmológico de Alicante, Avda Denia, sn. Edificio VISSUM, Alicante, Spain. Tel: 34 965 150 025; E-mail: <A HREF="mailto:jjavaloy@coma.es">jjavaloy@coma.es</A>; <A HREF="mailto:rdioa@vissum.com">rdioa@vissum.com</A></P> <P>Received: June 13, 2007</P> <P>Accepted: November 7, 2007</P> <P><B>Posted online: January 31, 2008</B></P>

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 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. 6 presented a case in which interface fl uid accumulation was associated with interface infl ammation and epithelial ingrowth after LASIK.…”

Peripheral Ulcerative Keratitis following Laser in situ Keratomileusis

“…Late-onset DLK can be associated with systemic inflammatory conditions (9 months to 4 years after LASIK as reported in the literature) [ 19 , 20 ]; however, in this patient case, DLK occurred within 5 days. It may have occurred with influx of inflammatory cells due to delayed or problematic wound healing at the flap margins [ 21 ] or due to the epithelial defects [ 22 ].…”

LASIK interface keratitis: epidemiology, diagnosis and care

“…However, in the vast majority of late-onset cases, some inciting event occurs, an epithelial defect (often related to a recurrent erosion), flap dislocation, or an infectious or inflammatory trigger. Although it has been shown that patients with underlying autoimmune disease can safely undergo LASIK [43], one should also be aware that inflammatory diseases and associated ocular inflammation can trigger an episode of DLK [44 , [45][46][47]. Although bacterial keratitis can precede DLK [48], DLK has also been reported associated with viral keratoconjunctivitis [49], gonococcal keratoconjunctivitis [50] and orbital cellulitis [51].…”