Diffuse Lamellar Keratitis: Confocal Microscopy Features of Delayed-Onset Disease

Area of Science:

• Ophthalmology
• Corneal Surgery
• Laser Vision Correction

Background:

• Diffuse lamellar keratitis (DLK) is an uncommon complication following laser in situ keratomileusis (LASIK).
• DLK typically manifests within one week of LASIK surgery as an inflammatory reaction in the corneal lamellar interface.
• Delayed onset DLK can lead to corneal scarring and significant vision loss if not managed promptly.

Observation:

• A case of bilateral diffuse lamellar keratitis (DLK) with delayed onset, occurring three months after LASIK for high myopia, is presented.
• The patient exhibited clinical signs of DLK with no prior risk factors for delayed presentation.
• Confocal microscopy was utilized to examine the corneal interface features before and after treatment.

Findings:

• The patient presented with delayed-onset DLK, characterized by inflammatory cells and interface debris, which is atypical for stage 3 DLK.
• Initial treatment with topical antibiotics and steroids showed a poor response.
• Interface washout combined with continued topical steroid treatment led to the resolution of DLK in both eyes.

Implications:

• Delayed-onset DLK requires intensive management, including aggressive steroid therapy and potentially surgical intervention like interface washout.
• Confocal microscopy can provide insights into the cellular-level changes in delayed DLK.
• Prompt and intensive treatment is crucial to prevent visual impairment from delayed DLK after LASIK.