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Case Reports
. 2018 Nov 14;9(3):457-464.
doi: 10.1159/000493338. eCollection 2018 Sep-Dec.

Diagnosis, Clinical Trend, and Treatment of Diffuse Lamellar Keratitis after Femtosecond Laser-Assisted in situ Keratomileusis: A Case Report

Angelo Balestrazzi  1 , Alessandra Balestrazzi  2 , Maria Ilaria Giannico  3 , Paolo Michieletto  2 , Emilio Balestrazzi  3
Affiliations
Case Reports

Diagnosis, Clinical Trend, and Treatment of Diffuse Lamellar Keratitis after Femtosecond Laser-Assisted in situ Keratomileusis: A Case Report

Angelo Balestrazzi et al. Case Rep Ophthalmol. .

Abstract

We report a severe case of diffuse lamellar keratitis (DLK) following femtosecond laser-assisted in situ keratomileusis (femto-LASIK). A 25-year-old man was submitted to 150 kHz iFS® IntraLase-assisted LASIK in both eyes for compound myopic astigmatism. The day after surgery, clinical examination showed a diffuse whitish granular cell reaction particularly in the right eye. High-dose dexamethasone eyedrops with topical antibiotic and artificial tears were prescribed. Five days after surgery, a central corneal opacity with convergent striae was detected at biomicroscopy. The suspicion of DLK was confirmed. Additional therapy based on hyperosmolar ophthalmological solution, oral doxycycline, and topical 10% sodium citrate was prescribed. Treatment was continued and tapered for over 3 months. Improvement in corneal transparency were obtained 2 weeks after the systemic therapy had been started. Uncorrected visual acuity improved from 20/32 to 20/20 at 1-year follow-up. DLK represents an infrequent complication after femto-LASIK. It should resolve without sequelae if promptly diagnosed and treated, without necessity of corneal flap lifting.

Keywords: Diffuse lamellar keratitis; Femtosecond laser; LASIK.

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Figures

Fig. 1.
Fig. 1.
Corneal topography, tangential map, of the right eye (upper line, from left to right) and of the left eye (bottom line, from left to right) during follow-up. a Before surgery. b One month after surgery. c Three months after surgery. d Six months after surgery. e One year after surgery.
Fig. 2.
Fig. 2.
Digital slit lamp images of the corneal surface of the right eye (left column) and of the left eye (right column) during follow-up. a, b One day after surgery. c, d Five days after surgery. e, f One month after surgery. g, h Three months after surgery, i, j One year after surgery.
Fig. 3.
Fig. 3.
OCT of the anterior segment of the right eye (left column) and of the left eye (right column) during follow-up. a, b Five days after surgery. c, d One month after surgery. e, f Three months after surgery. g, h Six months after surgery. i, j One year after surgery.
See this image and copyright information in PMC

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