Delayed onset diffuse lamellar keratitis following enhancement LASIK surgery

Diffuse lamellar keratitis (DLK) is a relatively uncommon complication of the refractive procedure, laser-assisted in situ keratomileusis (LASIK). If detected and diagnosed in a timely fashion, it can be treated and should resolve with minimal sequelae. If untreated, or misdiagnosed and treated incorrectly, there may be loss of visual acuity. Optometrists should be familiar with this condition, its signs, symptoms and correct treatment protocol.

A 58-year-old male Caucasian developed delayed onset diffuse lamellar keratitis, seemingly in the absence of an epithelial defect, 25 days following an enhancement LASIK procedure to his right eye. The DLK in this patient is delayed longer than typically reported in the literature. Subsequent management with topical steroids was complicated as the patient was a steroid responder and developed a markedly raised intraocular pressure that was managed with a topical anti-glaucoma agent. The diagnosis, pathogenesis and issues relevant to the treatment of this condition are discussed.

Optometrists, particularly those actively participating in the shared care of refractive surgery patients, must be familiar with diffuse lamellar keratitis so that diagnosis is not delayed. As the number of cases of refractive surgery in Australia increases, optometrists will encounter this condition more frequently.