Diffuse Lamellar Keratitis Ten Years after LASIK

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Diffuse Lamellar Keratitis Ten Years after LASIK

• Elena Basli, Barbara Ameline, Jean-Christophe
  Gavrilov, Laurent Laroche, Vincent Borderie
• Quinze-Vingts National Hospital, Paris, France
• All co-authors would like to disclosure the lack
  of any financial interest.

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Purpose

• To report a case of Diffuse Lamellar Keratitis
  (DLK) secondary to bacterial corneal ulcer, 10
  years after LASIK

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Materials

• A 35 years old man with a myopia of - 8 dioptries
  on both eyes, underwent uneventful lasik in 1996
  on his right eye and PKR on his left eye.
• Undercorrection led him to wear soft contact
  lenses after one year.
• Ten years later he was referred to us complaining
  of pain, blurred vision, foreign body sensation,
  and light sensitivity in his right eye

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Clinical examination at the emergencies

• Corrected VA on his right eye 12 / 60.
• Slit lamp examination ulceration of the cornea
  with peripheral infiltrates, punctuate epithelial
  keratitis, folds of the Descemet membrane,
  secondary anterior uveitis with Tyndall (2) and
  
• Infiltrates of the interface aggregating in the
  central visual axis. (Sands of the Sahara
  syndrome, Stage 3)

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Treatment

• Initial instillation of topical fortified
  antibiotics at hourly intervals were applied
  (Ticarcillin, Gentamycin and Vancomycin) for the
  first 3 days, cycloplegics (atropine 1) and
  artificial eye drops
• Corneal tissue retrieval, microbiological
  analysis of the contact lens, HRT and OCT Visante
  were performed

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Evolution

• Day 3 the response to antobiotic therapy was
  favourable on the ulcer. Interface didnt
  improve. We therefore initiated topical steroids
  (conjunctival injections) on day 3 and reduced
  the frequency of antibiotics instillation at 6
  times daily.
• Day 7 improvement was confirmed, fortified
  drops were substituted for weaker commercial
  preparation of Tobramycin, Dexamethasone,
  Cefuroxim and artificial eye drops
• Day 15 VA 10/10 with -4.50(-2.25)135,
  interface was cleared
• Results of corneal tissue retrieval were negative
  but those of the lens were positive for
  pyocyanic.

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Conclusions

• DLK can occur not only months but even years,
  after surgery in case on an epithelial trauma,
  loss of epithelial integrity with or without
  bacterial inflammation or disruption of the flap.
  
• Quick diagnosis and treatment are mandatory
• Antibacterial treatment associated with
  aggressive steroid therapy allow complete
  recovery
• Response to treatment was in this case comparable
  to an early Diffuse Lamellar Keratitis (DLK)