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A Case Report of Diffuse Lamellar Keratitis after FemtoSMILE Refractive Surgery
1Department of Surgery, Faculty of Medicine, Najran University, Najran, Saudi Arabia.
Abstract:
Diffuse lamellar keratitis (DLK) is not an uncommon complication of the small-incision lenticule extraction (SMILE) operation. Instrumental causes, such as contamination, are usually the underlying etiological route. Herein, we present an atypical case of DLK with numerous foci of cellular infiltrates on day 1. No evidence of any diffuse inflammatory response was reported. On the other hand, the multifocal response began to improve starting on the third day, after the administration of systemic steroids, with pain and discomfort significantly disappearing on the second day. Antibiotics were given as well, in the case of secondary infections. After 1 week of treatment and close monitoring, significant improvement was reported, and the slit-lamp examination was unremarkable.
Insights
Atypical diffuse lamellar keratitis (DLK) after small-incision lenticule extraction (SMILE) presented as multifocal infiltrates. Systemic steroids and antibiotics led to significant improvement within a week.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Inflammatory Eye Conditions
Background:
- Diffuse lamellar keratitis (DLK) is a known complication following small-incision lenticule extraction (SMILE).
- Instrumental factors, including contamination, are typical causes of DLK.
- Atypical presentations of DLK require careful clinical evaluation and management.
Observation:
- An atypical case of DLK presented with numerous foci of cellular infiltrates on postoperative day 1.
- No diffuse inflammatory response was observed initially.
- The multifocal infiltrates showed improvement by day 3.
Findings:
- Systemic steroid administration led to significant improvement in DLK symptoms, including pain and discomfort, by day 2.
- Antibiotics were administered to manage potential secondary infections.
- Close monitoring and treatment resulted in unremarkable slit-lamp examination findings after 1 week.
Implications:
- This case suggests that atypical, multifocal DLK following SMILE can be effectively managed with systemic steroids and antibiotics.
- Early recognition and prompt treatment are essential for favorable visual recovery.
- Further research into the specific etiological factors of atypical DLK in SMILE patients may be warranted.
