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.
Purpose

   To report a case of Diffuse Lamellar
    Keratitis (DLK) secondary to bacterial
    corneal ulcer, 10 years after LASIK
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
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)
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
    Evolution
   Day 3 : the response to antobiotic therapy was
    favourable on the ulcer. Interface didn’t 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.
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)

				
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