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Diffuse lamellar keratitis after laser in situ keratomileusis imaged by confocal microscopy
J Bühren1, M Baumeister, T Kohnen
1Department of Ophthalmology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
Objective:
To report the confocal microscopic findings of two different cases of diffuse lamellar keratitis (DLK) after primary laser in situ keratomileusis (LASIK) and LASIK flap relifting.
Design:
Observational case report of two cases.
Methods:
Two cases of DLK with different clinical appearances after primary LASIK and LASIK flap relift were selected. A third case of uneventful LASIK was selected as control case. Examination with a white-light tandem slit-scanning confocal microscope was performed in addition to routinely applied slit-lamp biomicroscopy.
Results:
In both cases, confocal microscopic examination showed infiltration of cells considered most likely to be mononuclear cells and granulocytes into the flap interface. Under treatment with topical steroids, the inflammation was reduced in both cases, to a minimum within 1 week, without loss of visual acuity. At this stage, only remnants of the granulocytelike cells, but not active inflammation, were imaged by confocal microscopic examination.
Conclusions:
Our findings confirm the clinical observation that DLK is an inflammation confined to the flap interface. Confocal in vivo microscopy could be a useful noninvasive tool to study the course of DLK in humans.