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Diffuse lamellar keratitis after epi-off corneal crosslinking: An under-recognized complication?
Diana B Mannschreck1, Roy S Rubinfeld2,3,4, Uri S Soiberman1
1The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
American Journal of Ophthalmology Case Reports
|February 2, 2019
Summary
Diffuse lamellar keratitis (DLK) can occur after epithelium-off corneal cross-linking (CXL) for post-LASIK ectasia. Transepithelial CXL (TE-CXL) successfully treated progressive ectasia and prevented DLK recurrence.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Refractive Surgery
Background:
- Post-LASIK ectasia is a sight-threatening complication.
- Corneal cross-linking (CXL) is a common treatment for ectasia.
- Epithelium-off CXL (epi-off CXL) is frequently used, but carries risks like DLK.
Observation:
- A patient with post-LASIK ectasia developed Grade II DLK after undergoing epi-off CXL.
- Despite DLK treatment, the patient's ectasia progressed, leading to decreased visual acuity.
- A subsequent treatment combining transepithelial CXL (TE-CXL) and conductive keratoplasty (CK) stabilized the ectasia and improved vision.
Findings:
- Epi-off CXL, while intended to treat ectasia, was complicated by DLK in this case.
- The initial epi-off CXL failed to halt the progression of post-LASIK ectasia.
- TE-CXL, combined with CK, successfully managed the progressive ectasia without inducing DLK.
Implications:
- Careful monitoring for DLK is crucial after epi-off CXL for post-LASIK ectasia.
- TE-CXL may offer a safer alternative for treating post-LASIK ectasia, potentially reducing DLK risk.
- This case highlights the potential of TE-CXL and CK as a combined treatment for progressive post-LASIK ectasia.
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