Late-onset diffuse lamellar keratitis following laser in situ keratomileusis

To analyze 12 cases of late-onset diffuse lamellar keratitis (DLK) following uncomplicated LASIK and propose a method of management.

Retrospective observational case series, literature review.

Patients who developed late-onset DLK following LASIK.

Retrospective chart review of all patients with late-onset DLK from January 2014 to August 2015. Data collected included demographic information, probable cause of DLK, stage of DLK, baseline examination, treatment, clinical course, outcomes, complications, and last follow-up examination. Review of relevant literature included searching for all prior cases and case series relating to "diffuse lamellar keratitis," "late-onset DLK," "Secondary Sands," and "delayed-onset DLK" by searching PubMed with these search terms.

Twelve eyes of 11 patients presented with late-onset DLK following LASIK. Onset ranged from 8 months to 17 years following LASIK. Stage of DLK ranged from stage I to III, and all patients responded well to aggressive corticosteroids without lifting of the LASIK flap. Final visual acuity for stage I/II and III eyes did not demonstrate a significant difference (p = 0.218). DLK resolved by a mean of 4.86 weeks for all eyes.

Late-onset DLK can present at any time following LASIK with a wide range of inciting factors causing a nonspecific (and likely immune-related) inflammatory reaction. Based on our findings, aggressive oral and topical corticosteroids should be tried before lifting the LASIK flap as long as infection is not suspected or inciting debris is not seen in the flap because the vast majority resolve with such therapy.